Delayed Diagnosis of Bilateral Posterior Shoulder Fracture-Dislocation Following a Seizure: A Case Report.

BACKGROUND Bilateral posterior shoulder fracture-dislocation can be caused by forced internal rotation during a seizure and requires management with combined open reduction procedures to address instability and fractures to restore function. This report describes the case of a 27-year-old man with a delayed diagnosis of bilateral posterior shoulder fracture-dislocation following a seizure managed by bilateral open reduction, fixation of the greater tuberosity, biceps tenodesis, and subscapularis anchor repair using a deltopectoral approach. CASE REPORT A 27-year-old man with no prior history of epilepsy presented with bilateral shoulder pain and severe functional limitation following a tonic-clonic seizure. Initial evaluation did not include shoulder imaging, resulting in delayed diagnosis. Over the following weeks, he developed progressive pain, weakness, and restriction of motion. Radiographs and computed tomography (CT) confirmed bilateral posterior shoulder fracture-dislocation with associated greater tuberosity fractures. Magnetic resonance imaging (MRI) demonstrated preserved rotator cuff integrity. He underwent bilateral open reduction through a deltopectoral approach, including fixation of the greater tuberosity, biceps tenodesis, and subscapularis repair with suture anchors. Both shoulders were immobilized for 3 weeks, followed by structured physiotherapy. At final follow-up, the patient had achieved full, pain-free range of motion (ROM), with significant functional improvement reflected by an increase in Constant (a validated clinical scoring system for shoulder function) scores from 4 points to 95 points bilaterally. CONCLUSIONS Early recognition of posterior shoulder dislocation is essential to avoid chronic disability. However, even in delayed cases, anatomical reconstruction combined with soft tissue repair and structured rehabilitation can restore excellent shoulder function when joint integrity is preserved.