Bilateral Shoulder Dislocation with Fracture of Major Tubercles - A Case Report.

INTRODUCTION: Bilateral dislocations of the glenohumeral joint are most often posterior, secondary to convulsive seizures. We report a case of bilateral anterior dislocation with fracture of the two major tubercles following a very rare mechanism.

CASE REPORT: A 52-year-old patient admitted at the emergency department for bilateral closed shoulder trauma following a tonic-clonic seizure. The patient had a blood pressure of 160/100 mm Hg and a clear consciousness. Symmetrical and bilateral clinical examination of the shoulders shows the signs of bilateral anterior dislocation of the shoulders. The vascular and nerve examinations were normal. Standard shoulder X-ray showed bilateral dislocation in its anterior subcoracoid variety associated with fracture of the major tubercles. The blood test performed showed severe hyponatremia at 113 mmol/L. The dislocations were reduced by the Milch maneuver under sedation. The X-rays showed the reductions. Both shoulders were immobilized with an orthosis and cushion in mild abduction for 4 weeks. The patient stayed in the cardiology department for the management of hypertension and hyponatremia. He benefited the functional rehabilitation sessions after the removal of the orthosis. At the last follow-up at 9 months of the trauma, the shoulders were stable, painless, without recurrence or instability with a normal lifestyle and a muscular strength of 4/5.

CONCLUSION: This case highlights the importance of general exam and anamnesis in bilateral shoulder dislocations with major tubercles fractures following a tonic-clonic hypertensive convulsion. The treatment is multidisciplinary with orthopedic and cardiological.