Asif Nazir Baba, Javid A Bhat, SD Paljor, Naseer A Mir, Suhail Majid
Dept. of Orthopedics, SKIMS Medical College, Bemina, Srinagar, Jammu and Kashmir, India
Correspondence Address:
Asif Nazir Baba
Department of Orthopedics, SKIMS Medical College, Bemina, Srinagar, Kashmir
India
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DOI: 10.4103/0973-6042.34026
Abstract
Inferior dislocation of the shoulder, also called luxatio erecta, is a rare form of the otherwise common shoulder dislocation. It accounts for less than 0.5% of all shoulder dislocations. A case involving the inferior dislocation of the shoulder is reported. A brief review of the presentation and management of the condition is described.
Keywords: Dislocation, luxatio erecta, shoulder
How to cite this article:
Baba AN, Bhat JA, Paljor S D, Mir NA, Majid S. Luxatio erecta: Inferior glenohumeral dislocation. Int J Shoulder Surg 2007;1:100-2
How to cite this URL:
Baba AN, Bhat JA, Paljor S D, Mir NA, Majid S. Luxatio erecta: Inferior glenohumeral dislocation. Int J Shoulder Surg [serial online] 2007 [cited 2013 Apr 19];1:100-2. Available from: http://www.internationalshoulderjournal.org/text.asp?2007/1/3/100/34026
Introduction Top
The shoulder joint is the most mobile of all the joints in the body. However, it has to pay the price for its mobility by being the most frequently dislocated joint. Amongst the types of shoulder dislocations, inferior dislocation (luxatio erecta) is a rare form, comprising only 0.5% of shoulder dislocations. Luxatio erecta is usually associated with neurological complications which fortunately resolve most of the times following the reduction. Vascular complications also accompany the dislocation in a significant number of patients.
Case Report Top
A 16-year-old boy presented to the casualty of the SKIMS Medical College with a history of fall from a height of 10 feet. The patient had severe pain in his right shoulder and inability to move the shoulder. History suggested a fall on to his right side with the arm outstretched. On examination, the right shoulder was in 110 degrees of abduction and in external rotation, elbow flexed and the hand resting on the head. There was a superficial wound in the axilla [Figure – 1]. The head of humerus was palpable in the axilla. Distal vascular status was normal. Full neurological assessment was difficult, but the patient was able to move elbow, wrist and fingers normally. No sensory deficit was present. Active movement of the right shoulder was absent and the passive movements were painful. Radiographs (AP and axillary views) revealed the head of humerus lying inferior to the glenoid fossa and the humerus directed upwards [Figure – 2]. A diagnosis of inferior dislocation of the shoulder was made.
Under general anesthesia, the wound was thoroughly debrided and primarily closed. Closed reduction was done, with the traction applied upwards and outwards, while the counter- traction was applied over the top of the shoulder and across the chest to the opposite side of the body. Post-reduction radiographs were normal [Figure – 3]. Neurovascular status was normal. Shoulder was immobilized for three weeks and gradual range of motion exercises was started. The patient regained full range of motion and returned to his job after 12 weeks [Figure – 4].
Discussion Top
Inferior dislocation of the shoulder was first described by Middeldorpf and Scharus in 1859. [1] Lynn [2] reviewed 34 cases and Roca and Ramos Vertiz [3] described about 50 cases. Bilateral dislocation has been described by a number of authors including Langovitz [4] , Murrad [5] , Piero [6] and Kumar [7] .
Luxatio erecta is produced by a hyperabduction force that causes the impingement of the neck of humerus against the acromion process. This, in turn, levers the head out inferiorly. The humerus is then locked with the head below the glenoid fossa and the humeral shaft pointing overhead.
Luxatio erecta may be associated with soft tissue, bony, neurological or vascular injuries. [8] Mallon [9] reviewed 80 cases and reported greater tuberosity fracture or rotator cuff injury in 80%, neurological involvement in 60% and vascular compromise in 3.3% cases. Soft tissue injuries include rotator cuff lesions, supraspinatus avulsion, avulsion of pectoralis major and subscapularis rupture. Schai and Hinterman [10] performed arthroscopic assessment and found extensive detachment of the labral biceps tendon complex (SLAP lesion) in luxatio erecta patients. Dislocation may have associated fractures with it. The more common ones are those involving the acromion, clavicle, coracoid process, greater tuberosity and humeral head. [11],[12] Vascular injuries are serious and require surgical intervention most of the times. [13],[14] Axillary vessels are the most commonly involved. Neurological involvement is common, the axillary nerve being the most commonly affected. Brachial plexus injury must always be sought for in inferior dislocation, as it is a more common cause of morbidity, rather than the dislocation itself. Luckily, neurological injuries recover the most of times.
References Top
1. Middeldorpf M, Scharm B. De nova humeri luxationis specie. Clinique Eurpenne 1859;2:12-6. Back to cited text no. 1
2. Lynn FS. Erect dislocation of the shoulder. Surg Gynecol Obstet 1921;39:51-5. Back to cited text no. 2
3. Roca LA Ramos-Vertiz JR. Luxatio erecta de hombro. Rev San Mil Arg 1962;61:135. Back to cited text no. 3
4. Langfritz HV. Die doppelseitige traumatische luxatio humeri erecta sine seltene verletzunsform. Unfallheilkd 1956;59:367. Back to cited text no. 4
5. Murrad J. Un cas de luxatio erecta de l’epaule, double et symetrique. Rev Orthop 1920;7:423-9. Back to cited text no. 5
6. Piero A, Ferrandis R, Correa F. Bilateral erect dislocation of the shoulder. Injury 1974;6:294-5. Back to cited text no. 6
7. Kumar KS, O’Rourke S, Pillay JG. Hands up: A case of bilateral inferior shoulder dislocation. Emerg Med J 2001;18:404-5. Back to cited text no. 7 [PUBMED] [FULLTEXT]
8. Davids JR, Talbott RD. Luxatio erecta humeri: A case report. Clin Orthop Relat Res 1990;252:144-9. Back to cited text no. 8 [PUBMED] [FULLTEXT]
9. Mallon WJ, Basset FH, Goldner RD. Luxatio erecta: The inferior glenohumeral dislocation. J Orthop Trauma 1990;4:19-24. Back to cited text no. 9
10. Schai P, Hinterman B. Arthoscopic findings in luxatio erecta of the glenohumeral joint: A case report and review of literature. Clin J Sports Med 1998;8:138-41. Back to cited text no. 10
11. Lashkin RS, Sedlin ED. Luxatio erecta in infancy. Clin Orthop Relat Res 1971;80:126-9. Back to cited text no. 11
12. Meadowcroft JA, Kain TM. Luxatio erecta- shoulder dislocation: Report of two cases. Jefferson Orthop J 1977;6:20-4. Back to cited text no. 12
13. Gardham JR, Scott JE. Axillary artery occlusion with erect dislocation of the shoulder. Injury 1980;11:155-8. Back to cited text no. 13
14. Lev-El A, Rubinstein Z. Axillary artery by erect dislocation of the shoulder. J Trauma 1981;21:323-5. Back to cited text no. 14 [PUBMED]