Bilateral anterior shoulder dislocations after ground-level fall

Background

Despite being the most routinely encountered joint dislocation, bilateral anterior shoulder dislocation is a rare finding in a common Emergency Department complaint of mechanical ground level fall. High energy mechanisms of injury such as trauma, seizures, and electrocution are the most common causes of bilateral shoulder dislocation.

Case report

A 72-year-old male presents with simultaneous anterior dislocations of both shoulders after a fall while walking his dog. He arrived in the Emergency Department with arms above his head and xray imaging identified bilateral shoulder dislocations. After procedural sedation, the shoulders were successfully reduced without any evidence of neurovascular injuries and later discharged.

Why should an emergency physician be aware of this

?This mechanism of injury is rare among those who are diagnosed with bilateral shoulder dislocation and therefore, more likely to be missed. Where symmetry generally represents a person's normal anatomy, the apparent symmetric appearance in bilateral shoulder dislocation is misleading. Due to the infrequent occurrence, there is low clinical suspicion among emergency physicians leading to delayed diagnosis and associated complications.