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While doing seated behind-the-neck military presses, a young man of 22 years,
experienced bilateral anterior dislocation of the shoulders. He came into the
emergency department complaining of acute bilateral shoulder stiffness and pain.
He claimed to have been performing behind-the-neck military presses with a
108-lb (50kg) weight while being spotted by a training partner. While performing
the military presses, he suddenly felt that his shoulders were going out of
place, and lost control of the bar. Unfortunately, his training partner was
unable to prevent injury. The injured man stated that he felt immediate pain and
lost mobility of his arms. He was then rushed to the emergency department.
When the patient first arrived at the emergency department, his shoulders
were in abduction and external rotation. He complained of stiffness and pain.
Tests showed bilateral flattened contour of the shoulders below the tip of the
acromion. Anterior fullness was present, but luckily, the patient did not suffer
from any neurological or vascular injuries. Further examinations showed a
bilateral anterior shoulder dislocation but no fracture.
The young man was a
22-year-old, right-handed accountant, who had 3 years of weight training
experience. He was 5 ft 10 in. (178 cm) tall and approximately 180 lb (83.3 kg).
Upon investigation, the patient had no history of any type of injury to either
of his shoulders. None of his family had any history of hyper laxity disorders,
epilepsy, or convulsions as well. He had also had no alcohol within 24 hours of
his weight training session.
The patient was treated with 10 mg of
intravenous diazepam before reduction was achieved through Kocher's maneuver.
Radiological examinations taken after treatment showed that reduction was
successful. Reduction was performed by treating the patient with a bilateral
body bandage for 3 weeks. Weekly checkups took place through his regular
physicians. However, the patient underwent 6 weeks of physical therapy after the
bilateral body bandages were removed. The patient discontinued regular weight
lifting and regained full shoulder range of motion 6 months after the initial
occurrence. A follow-up 5 years later reported no redislocation.
Many
shoulder intensive sports such as baseball, tennis, and volleyball have been
responsible for many cases of symptomatic occult glenohumeral instability. These
sports often force the shoulder into an abnormal position of abduction and
external rotation, the same position required in the seated behind-the-neck
military presses performed by the patient mentioned above. Repetition of this
forceful abduction and external rotation technique adds more pressure at the end
of the extended lever arm thereby resulting in instability or even dislocation.
The joint is vulnerable to dislocation due its stability being largely dependent
on the strength and integrity of the surrounding soft tissues.
However,
bilateral simultaneous dislocation of the shoulders is quite uncommon. Most
cases are posterior and usually occur due to drug-induced seizures,
electroconvulsive therapy, or in patients with neuromuscular deficiencies or
severe emotional disturbances (psychogenic dislocation). Cases reported as
anterior most often occurred in patients who have epileptic seizures,
drug-induced seizures, or diabetic nocturnal hypoglycemia, and in patients who
have loose joints and dislocate shoulders while performing voluntary movements
or experiencing trauma. Some cases have been reported as occurring in weight
lifters.
Anterior dislocation of the shoulder most often occurs when
extension, abduction, or external rotation is forced on the arm, which then
levers the humeral head out of the glenoid fossa. Some cases indicate that a
direct blow on the posterior aspect of the shoulder or direct forward traction
can cause dislocation.
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