Abstract
Introduction:
Chronic shoulder dislocations are infrequent and can be easily
overlooked unless a carefully clinical history, physical examination,
and radiographic evaluation are undertaken. Bilateral simultaneous
instability is almost pathognomonic for a convulsive disorder. To the
best of our knowledge, we describe the first case of asymmetric
bilateral chronic dislocation.
Case report:
A 34-year-old male patient with a history of epilepsy and
schizophrenia and multiple seizure episodes, suffered a bilateral
asymmetric shoulder dislocation. Radiological examination revealed a
posterior shoulder dislocation of the right shoulder with a severe
reverse Hill-Sachs lesion comprising more than 50% of the humeral head
surface, while on the left shoulder, a chronic anterior shoulder
dislocation with a Hill-Sachs lesion of moderate dimension. On the right
shoulder, a hemiarthroplasty was performed, and on the left, a
stabilization with Remplissage Technique, subscapularis plication, and
temporary trans-articular Steinmann pin fixation was done. After
bilateral rehabilitation, the patient showed residual pain in the left
shoulder and slight range of motion limitation. There were no new
episodes of shoulder instability.
Conclusion:
Our aim is to emphasize the importance of being alert to flag
patients and make a prompt and accurate diagnosis of acute shoulder
instability episodes, to avoid unnecessary morbidity, as well as of a
high index of suspicion when a history of seizures is present. Despite
the uncertain prognosis of a bilateral chronic shoulder dislocation
functional results, the surgeon must take into consideration the
patient’s age, functional demand, and expectations to define the best
treatment strategy.