Presentation
Chronic shoulder complaints in teenager with history of epilepsy.
Patient Data
At age 13 years, these radiographs show subtle, bilateral alteration of the relation between the humeral head an glenoid. No Y-views were obtained. The partial ossification of the bony structures further complicates the interpretation.
An MRI whole-body obtained for other reasons shows the bilateral posterior dislocation of the humeral heads on one of the slides. This was not appreciated at the time.
At age 16 years, non-specific chronic complaints elicited a referral for repeat radiographs. In this instance, Y-views were obtained, unexpectedly showing bilateral posterior dislocation of the humeral heads.
A CT was acquired to confirm the diagnosis, showing again the bilateral posterior dislocation as well as bilaterally elevated lateral clavicles at the level of the acromioclavicular joint.
Case Discussion
Posterior dislocation of the shoulder is rare. When it does occur, it is relatively frequently associated with tonic-clonic epileptic attacks and in this setting, it can occur bilaterally. This rare pediatric case demonstrates how persisting dislocation can become permanent, reshaping the glenohumeral and acromioclavicular joints.