Bilateral anterior dislocation of the shoulders at the start of a backstroke competition
© The Author(s) 2012
Received: 27 March 2011
Accepted: 9 December 2011
Published: 9 February 2012
Bilateral anterior dislocation of the shoulders is very rare. A 20-year-old man presented with bilateral anterior shoulder dislocation as a result of a diving incident. He complained of pain and restriction of movement in both shoulders with abducted and externally rotated arms. Radiographs revealed that the shoulders were dislocated. The patient was treated with closed reduction and was able to resume swimming 3 months later. To our knowledge, this is the first bilateral anterior dislocation of the shoulders during a backstroke swimming competition that was caused by this mechanism of injury. The rarity of this lesion and its uncommon mechanism prompted us to relate this observation.
Although anterior shoulder dislocation is the most common major joint dislocation encountered by emergency physicians, bilateral glenohumeral dislocations are rare and almost always posterior . Such dislocations are usually caused by sports injuries, seizures, electrical shock, or electroconvulsive therapy [2, 3]. However, simultaneous bilateral anterior shoulder dislocation (BADS) is very rare: only about 30 cases have been described in the literature [2, 4–6]. We report a rare case involving traumatic bilateral dislocation of the shoulders as a result of a diving incident.
The patient consented to the publication of this case report.
Anterior shoulder dislocation is the most common major joint dislocation encountered in the emergency department. Its injury mechanism is forced extension, abduction, and external rotation. Anterior dislocation of the shoulder may occur in a violent contraction of the shoulder muscles or a direct blow to the posterior aspect of the shoulder. Because of the position naturally adopted by the upper extremity during a fall, unilateral anterior dislocation of the shoulder is common. Bilateral glenohumeral dislocations are rare and almost always posterior [1, 2, 4]. However, BADS is very rare: a review of the literature revealed about 30 reports of bilateral anterior shoulder dislocations, 15 of which were of fracture-dislocation. Most were due to violent trauma or electrocution; the remaining few were attributed to epileptic or hypoglycemic seizures [7, 8]. BADS was first described in 1902 in a patient with muscular contraction caused by a camphor overdose [2, 9]. Sports injuries, seizures, electrical shock, electroconvulsive therapy, drug overdose, neuromuscular disorders, and psychiatric disturbances have been implicated [2, 3, 8, 10–12]. Only one case was connected with a sporting activity: a water skier lost control at high speed and was thrown violently across the surface of the water . However, it was not reported whether the shoulders were dislocated by the forward pull of the tow-rope or during the fall, because it is not easy to imagine how a fall on the surface of the water would dislocate both shoulders. Our patient was a promising young swimmer who dislocated his shoulders while diving at the start of a backstroke race. This is the only competition swimming style that starts in the water. In backstroke, the arms contribute most of the forward movement. The stroke consists of two main parts: the power phase and the recovery. The dislocation usually occurs when the swimmer has the arm in the cocked position associated with hyperextension of the shoulders. The force can be strong enough to rupture the anterior capsule and glenohumeral ligament complex, resulting in anteroinferior dislocation. In addition to that, our young, inexperienced swimmer was unfortunately unfocused and highly stressed before the start of the race. Clinical diagnoses of dislocation types and associated injuries may be inaccurate without imaging [2, 10, 11]. Delayed diagnosis is not uncommon in bilateral shoulder dislocations resulted from electric shock or trauma [11, 14, 15]. Surgery is reserved for recurrent cases, which are mostly seen in patients who are <40 years of age [4, 16].
Conflict of interest
All authors disclose that they have no conflict of interest that could inappropriately influence this work. This study was self-funded.
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- Brown RJ (1984) Bilateral dislocation of the shoulders. Injury 15:267–273PubMedView ArticleGoogle Scholar
- Dunlop CC (2002) Bilateral anterior shoulder dislocation: a case report and review of the literature. Acta Orthop Belg 68:168–170PubMedGoogle Scholar
- Mehta MP, Kottamasu SR (1989) Anterior dislocation of the shoulders with bilateral brachial plexus injury. Ann Emerg Med 18:589–591PubMedView ArticleGoogle Scholar
- Devalia KL, Peter VK (2005) Bilateral post-traumatic anterior shoulder dislocation. J Postgrad Med 51:72–73PubMedGoogle Scholar
- Singh S, Kumar S (2005) Bilateral anterior shoulder dislocation: a case report. Eur J Emerg Med 12(1):33–35PubMedView ArticleGoogle Scholar
- Cresswell TR, Smith RB (1998) Bilateral anterior shoulder dislocations in bench pressing: an unusual cause. Br J Sports Med 32(1):71–72PubMed CentralPubMedView ArticleGoogle Scholar
- Sharma L et al (2005) Bilateral anterior dislocation of the shoulders with proximal humeral fractures: a case report. J Orthop Surg 13(3):303–306Google Scholar
- Litchfield JC, Subhedar VY, Beevers DG, Patel HT (1988) Bilateral dislocation of the shoulders due to nocturnal hypoglycaemia. Postgrad Med J 64:450–452PubMed CentralPubMedView ArticleGoogle Scholar
- Myenter H (1902) Subacromial dislocation from muscular spasm. Ann Surg 36:117–119View ArticleGoogle Scholar
- Goga IE (2003) Chronic shoulder dislocations. J Shoulder Elbow Surg 12:446–450PubMedView ArticleGoogle Scholar
- Costigan PS, Binns MS, Wallace WA (1990) Undiagnosed bilateral anterior dislocation of the shoulder. Injury 21:409PubMedView ArticleGoogle Scholar
- Mihai R, Dixon JH (1999) Bilateral atraumatic dislocation of the shoulder. J Accid Emerg Med 16(6):460PubMed CentralPubMedView ArticleGoogle Scholar
- Segal D et al (1977) Acute bilateral anterior dislocation of the shoulders. Clin Orthop 140:21Google Scholar
- Fish RM (2000) Electric injury, part II: specific injuries. J Emerg Med 18:27–34Google Scholar
- Thomas DP, Graham GP (1996) Missed bilateral anterior fracture dislocations of the shoulder. Injury 27:661–662PubMedView ArticleGoogle Scholar
- Saragaglia D et al (2001) Anterior instability of the shoulder: short and medium term results with orthopaedic treatment. J Orthop Surg 87:215–220Google Scholar