Bilateral luxatio erecta

A 58-year-old man fell 15 feet when the base of his ladder slid backwards. The man landed in a prone position, with his arms abducted above his head, holding the upper rung of the ladder. He was transported to the Emergency Department by ambulance. He denied loss of consciousness or amnesia to the event. He complained of bilateral shoulder pain and inability to adduct his arms.

On examination, the vital signs were normal. The musculoskeletal examination was remarkable in that the patient had both arms abducted over his head. The patient was unable to adduct his arms. Radial artery pulses were normal and palpable in both the wrists. No sensory or motor deficits were detected in the hands.

An anteroposterior radiograph of the chest was obtained (Figure 1). The radiograph revealed bilateral inferior glenohumeral dislocation (luxatio erecta). Anteroposterior (Figure 2) and axillary (Figure 3) radiographs were taken of each shoulder, revealing the humeral head to be in an inferior position in relation to the glenoid fossa. No other injuries were identified.

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Figure 1. The AP chest radiograph shows bilateral glenohumeral dislocations, evidenced by the humeral heads (*) lying below the empty glenoid fossa (arrows) bilaterally. Both arms are in full abduction. C, clavicle.

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Figure 2. Anterior view of the left shoulder shows an empty glenoid fossa (arrow) with the humeral head below the level of the glenoid fossa (*). Note that the arm is in abduction. The clavicle (C) and acromion (A) are visible above the glenoid fossa.

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Figure 3. Axillary view of the left shoulder shows an empty glenoid fossa (arrow) with the humeral head below the level of the glenoid fossa (*). The clavicle (C) and acromion (A) are visible above the glenoid fossa.

Fentanyl and Versed were administered to achieve conscious sedation. The right glenohumeral dislocation was reduced with traction in a cephalad plane and subsequent adduction in an arc toward the ipsilateral flank. Countertraction was applied using a sheet around the patient’s thorax. The reduction was performed easily. The left glenohumeral dislocation was reduced in the same manner. Both arms were placed in slings without swaths, as swathing both arms was considered a safety hazard. A post-reduction radiograph shows the humeral head to be in the glenoid fossa (Figure 4).

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Figure 4. Post-reduction anteroposterior view of the left shoulder shows the humeral head (*) approximated to the glenoid fossa (arrow), with the arm in adduction. C, clavicle; A, acromion.

After recovery from conscious sedation, the patient was discharged home. He was instructed to avoid abducting his arms until seen at follow-up. At 2-week follow-up, the patient had recovered full use of his upper extremities. He had discontinued his slings 1 week after injury. He reported no sensory deficits.