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 Table of Contents  
CASE REPORTS
Year : 2022  |  Volume : 37  |  Issue : 1  |  Page : 23-25

Bilateral anterior shoulder dislocation following seizures in eclampsia


1 Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College and Hospital (JNMCH), Aligarh Muslim University (AMU), Aligarh, Uttar Pradesh, India
2 Jawaharlal Nehru Medical College and Hospital (JNMCH), Aligarh Muslim University (AMU), Aligarh, Uttar Pradesh, India

Date of Submission26-Jan-2022
Date of Acceptance12-Apr-2022
Date of Web Publication13-May-2022

Correspondence Address:
Mohammad Jesan Khan
Department of Orthopaedic Surgery, Faculty of Medicine, Jawaharlal Nehru Medical College and Hospital (JNMCH), Aligarh Muslim University (AMU), Aligarh, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jbjd.jbjd_2_22

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  Abstract 

Pain in the shoulders following seizure episodes should raise suspicion of a shoulder dislocation. As these injuries can be missed very easily in an unconscious patient, thorough clinical examination is of paramount importance in such cases. This is a case report of a 26-year-old female patient diagnosed as a case of bilateral anterior shoulder dislocation secondary to seizures as a complication of eclampsia. Patient was managed by closed reduction under anesthesia and reduction was performed successfully. A case report is mentioned in the literature about unilateral shoulder dislocation following seizures in eclampsia but to the best of our knowledge, no such case is mentioned about bilateral shoulder dislocation.

Keywords: Bilateral anterior shoulder dislocation, eclampsia, pregnancy, seizures


How to cite this article:
Khan MJ, Singhal U, Aziz MH, Asif S. Bilateral anterior shoulder dislocation following seizures in eclampsia. J Bone Joint Dis 2022;37:23-5

How to cite this URL:
Khan MJ, Singhal U, Aziz MH, Asif S. Bilateral anterior shoulder dislocation following seizures in eclampsia. J Bone Joint Dis [serial online] 2022 [cited 2022 May 25];37:23-5. Available from: http://www.jbjd.in/text.asp?2022/37/1/23/345161




  Introduction Top


Anterior shoulder dislocation is a common entity, which presents in the emergency department. However, most of them are unilateral cases and mostly occur due to trauma.[1] Bilateral shoulder dislocation is a rare presentation and a posterior dislocation is more common as compared to an anterior dislocation in seizures.[2] Bilateral anterior dislocation due to seizures is a rare presentation.[3] This case report describes bilateral anterior shoulder dislocation following seizures in a 26-year-old postpartum patient with eclampsia.


  Case Presentation Top


A 26-year-old female presented to orthopedics OPD with complaints of bilateral shoulder pain and inability to move her both arms for the past 3 days. Patient was 36 weeks pregnant and suffered multiple episodes of seizures following which she was taken to the hospital where she was intubated due to low GCS (7/15). Her cesarean section was done the same day and she was shifted to ICU due to poor general condition. She was diagnosed as a case of primigravida with eclampsia with pulmonary edema with posterior reversible encephalopathy syndrome (PRES). Postoperatively on day 3 the patient’s general condition improved and was extubated as she regained consciousness and shifted out of ICU. Following this, she started complaining of pain in bilateral shoulders which was not relieved even on taking painkillers. For this orthopedic consultation was taken by obstetricians and on examination bilateral loss of normal contour of the shoulder was present and both her arms were externally rotated. Head of the humerus was palpated anteriorly and active and passive movements were painfully restricted. There was no distal neurological/vascular deficit.

X-rays were done and the patient was diagnosed as a case of bilateral anterior shoulder dislocation [Figure 1] and following which she was immediately taken inside OT and under general anesthesia (GA) closed reduction was achieved using traction-countertraction method, and reduction was checked both clinically and under image intensifier.
Figure 1: X-ray showing bilateral shoulder joint dislocation

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Reduction was confirmed radiographically with X-rays [Figure 2] and the patient was discharged under satisfactory conditions. Post-reduction shoulder was immobilized with bilateral shoulder immobilizer for 4 weeks.
Figure 2: Post-reduction X-ray after reduction under image intensifier

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  Discussion Top


Following a convulsive episode, the shoulder usually dislocates posteriorly.[4] The reason behind posterior dislocation in seizures is the abrupt and synchronous contractions of the powerful internal rotators which overcome the contractions by weak external rotators and posterior fibers of deltoid. The succeeding adduction and internal rotation cause the shoulder to usually dislocate posteriorly.[4],[5]

Only one case of anterior shoulder dislocation is mentioned in the English literature thus making it a rare complication of eclampsia.[5] Other orthopedic injuries reported previously due to eclampsia include parturition-induced pelvic dislocation in the form of symphysis pubis rupture, sacroiliac joint disruption, fractures, and simultaneous bilateral central dislocation of hip.[6] Anterior dislocation of shoulder is an uncommon complication of any convulsive disorder caused by epilepsy, electro-convulsive therapy, or electric shock. Although there are case reports about anterior dislocation of bilateral shoulder joints, mainly they are reported as a consequence of trauma following convulsive crisis like fall on the ground but not in particular to eclampsia.[7] Most of these bilateral cases are missed and diagnosed late, which makes their management difficult.

In this case, the shoulder dislocation most probably occurred during the convulsive episodes, which was missed by the obstetrician or the treating physician since the patient could not complain of pain due to drowsy state. Since the injury was bilateral, the treating doctor could not note the abnormal attitude of the limb. It was only diagnosed when the patient regained consciousness and started complaining of pain which was not relieved even on painkillers. It could have very easily led to a delayed diagnosis had the patient not regained consciousness within 3 days. Had the obstetrician been aware of such a complication of eclampsia, early diagnosis would have been possible and it could have been easily screened under image intensifier when cesarean section was being done and reduction could have been achieved at that time only by the orthopedic team.

High suspicion and thorough clinical and radiological examination of the shoulders are the key to early diagnosis and treatment of such complications after any convulsive attack. This is particularly important in reference to patients with eclampsia.

Recurrence following reduction could happen and the patient thus needs regular follow-up.


  Conclusion Top


Bilateral anterior shoulder dislocation following eclampsia can be missed very easily due to the unusual presentation.

Awareness about the possible complication and through physical and radiological examination could possibly avoid the delayed diagnosis and the situation can be dealt with early.

The emergency physician and obstetrician should be made aware of such complications and thus act accordingly.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Ethics approval and consent to participate

Approval for the study was taken from JNMCH, AMU, Aligarh ethical committee (institutional).

Availability of data and material

All data generated or analyzed during this study are included in this published article (and its supplementary information files, especially in tables).



 
  References Top

1.
Botha AH, Du Toit AB. Bilateral anterior shoulder dislocation: A case report of this rare entity. SA Orthopaedic Journal 2010;9:68-70.  Back to cited text no. 1
    
2.
Lasanianos N, Mouzopoulos G. An undiagnosed bilateral anterior shoulder dislocation after a seizure: A case report. Cases J 2008;1:342.  Back to cited text no. 2
    
3.
Ballesteros R, Benavente P, Bonsfills N, Chacón M, García-Lázaro FJ. Bilateral anterior dislocation of the shoulder: Review of seventy cases and proposal of a new etiological-mechanical classification. J Emerg Med 2013;44:269-79.  Back to cited text no. 3
    
4.
Din KM, Meggitt BF. Bilateral four-part fractures with posterior dislocation of the shoulder: A case report. J Bone Joint Surg Br 1983;65:176-8.  Back to cited text no. 4
    
5.
Rawat S, Meena S, Gangari SK, Lohia LK. Anterior dislocation of shoulder in eclampsia: A case report. Chin J Traumatol 2012;15:249-50.  Back to cited text no. 5
    
6.
Borg-Stein J, Dugan SA, Gruber J. Musculoskeletal aspects of pregnancy. Am J Phys Med Rehabil 2005;84:180-92.  Back to cited text no. 6
    
7.
Kelly JP. Fractures complicating electro-convulsive therapy and chronic epilepsy. J Bone Joint Surg Br 1954;36-B:70-9.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2]



 

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Abstract
Introduction
Case Presentation
Discussion
Conclusion
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