Anterior shoulder fracture dislocation

Case contributed by Safwat Mohammad Almoghazy

Presentation

The first episode of seizure and loss of consciousness

Patient Data

Age: 45 years
Gender: Male

Initial Radiograph

x_ray

Anterior shoulder fracture-dislocation of the left shoulder with mild displaced greater tuberosity.

Post reduction radiograph

x_ray

Post closed reduction radiograph show near-complete reduction of the glenohumeral joint but still minimal displaced of the greater tuberosity noted.  

An area of hypodensity is noted in the right frontal region predominantly involving the subcortical white matter with a speck of calcification along its periphery.

Possibility of underlying mass lesion to be considered and further evaluation with contrast MRI suggested.

A small rounded ring-enhancing subcortical right frontal lobe lesion, surrounded with perifocal edema, has a blooming effect on SWAN and correlated with CT finding denoting calcification.No restricted diffusion on DWI and ADC map. Suggesting of neurocysticercosis or tubercular granuloma.

Case Discussion

Epileptic seizures can cause shoulder dislocation and instability. This case of an example of anterior shoulder fracture-dislocation of his left shoulder following a seizure.

Magnetic resonance imaging (MRI) and correlated with CT of the brain findings suggestive of neurocysticercosis or tubercular granuloma as an epileptogenic focus.

Glenohumeral dislocation secondary to seizure disorders or electric shock is more frequently posterior, but it also occurs in an anterior direction.

The greater tuberosity is mildly displaced. A displaced greater tuberosity fracture usually signifies an associated rotator cuff injury and if not reduced anatomically can lead to permanent disability and decreased range of motion.

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