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Inferior shoulder dislocation (Luxatio erecta)

Case contributed by Leonardo Lustosa
Diagnosis certain

Presentation

Fall onto the outstretched hand height while riding a skateboard. Unable to adduct the right arm.

Patient Data

Age: 40 years
Gender: Male

The humeral head projects medial and inferiorly. The arm is abducted with the humeral shaft mostly parallel with the spine of the scapula. This indicates an inferior shoulder dislocation.

Case Discussion

Inferior shoulder dislocation, also known as luxatio erecta, is quite rare, accounting for <1% of all shoulder dislocations.

The typical presentation is an arm fixed in abduction, and the usual mechanism of trauma is a hyperabduction force to the arm.

The radiographic appearance of an inferior dislocation can be quite similar to an anterior dislocation, with the humeral head projecting medial and inferiorly to the glenoid. If an inferior dislocation is present, arm abduction will be noticed, with the humeral shaft parallel with the spine of the scapula. In contrast, in the case of the much more common anterior dislocation, the arm will be adducted, with the humeral shaft parallel with the chest wall.

In the present case, due to the locked abduction, lateral views could not be performed, which would further confirm the diagnosis.

It is important to properly recognize an inferior dislocation, as the reduction maneuvers differ from the anterior dislocation ones. In this case, closed reduction was performed successfully after imaging.

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