Luxatio Erecta

Introduction
Term for inferior dislocation of the glenohumeral joint is very rare, only 0.5% of all shoulder dislocations has greatest incidence of neurovascular injury of all types of shoulder dislocations
Anatomy
Glenohumeral anatomy
Presentation
Symptoms shoulder pain inability to move shoulder neurovascular injury Physical exam presents with the arm overhead with shoulder in full abduction, and elbow in flexion
Imaging
Radiographs inferior glenohumeral dislocation with arm fully abducted MRI can be obtained after shoulder is relocated to assess shoulder injuries may show capsulolabral pathology rotator cuff tears common
Treatment
Nonoperative closed reduction and immobilization indications good response to non-operative treatment inactive elderly patients technique initial reduction and immobilization followed by ROM exercises physical therapy focusing on rotator cuff strengthening Operative reconstruction with arthroscopic or open repair indications capsulolabral damage rotator cuff tear active younger patients technique repair vs reconstruction of shoulder pathology
Complications
Neurovascular injury axillary nerve palsy usually resolves with relocation of shoulder axillary artery thrombosis may occur late Rotator cuff tear especially in older patients

TAG

(OBQ09.252) A 35-year-old male injured his right shoulder while playing basketball. He presents emergently with significant pain and his shoulder abducted at 140 degree. He is unable to lower his arm. Radiographs will most likely show that his glenohumeral joint has dislocated in what direction? Topic

Review Topic

1. Anterior
2. Posterior
3. Superior
4. Inferior
5. Lateral

PREFERRED RESPONSE ▶

DISCUSSION: This patient has suffered an inferior shoulder dislocation (luxatio erecta). This is a rare type of shoulder dislocation, representing only about 0.5% of all shoulder dislocations. Anterior and posterior dislocations are much more common but don't present with a shoulder fixed in abduction or flexion such as this case. The cited articles by Seweckee and Fung report that this condition can be diagnosed by physical exam alone due to its unique presentation, but radiographs should be obtained to evaluate for concomitant injuries.

Since Pubmed does not have abstracts on these articles, the Fung article can be accessed at www.amjorthopedics.com/pdfs/037050097e.pdf

REFERENCES:

1. Sewecke JJ, Varitimidis SE. Bilateral luxatio erecta: a case report and review of the literature. Am J Orthop. 2006 Dec;35(12):578-80. PMID:17243409 (Link to Abstract)

2. Wirth MA, Rockwood CA Jr: Subluxations and dislocations about the glenohumeral joint, in Bucholz RW, Heckman JD (eds): Rockwood and Green’s Fractures in Adults, ed 5. Philadelphia, PA, Lippincott Williams & Wilkins, 2001, pp 1109-1207

3. Fung DA, Menkowitz M, Chern K. Asymmetric bilateral shoulder dislocation involving a luxatio erecta dislocation. Am J Orthop. 2008 May;37(5):E97-8. PMID:18587510 (Link to Abstract)

Question Authors:

Doug Nowak MD, Patrick McCulloch MD,

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Textbooks

Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012
AAOS Comprehensive Orthopaedic Review, Jay R. Leiberman. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2009
Orthopaedic Knowledge Update 10, John M Flyn. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2011
Hoppenfeld SP. Surgical Exposures in Orthopaedics: The Anatomic Approach. Lipponcott, Williams, and Wilkins, Philadelphia, PA, Copyright 2009
Orthopaedic In-training Examination (OITE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012
Self-Assessment Examination (SAE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012

Undefined

Sewecke JJ, Varitimidis SE. Bilateral luxatio erecta: a case report and review of the literature. Am J Orthop. 2006 Dec;35(12):578-80. PMID:17243409 (Link to Abstract)
Wirth MA, Rockwood CA Jr: Subluxations and dislocations about the glenohumeral joint, in Bucholz RW, Heckman JD (eds): Rockwood and Green’s Fractures in Adults, ed 5. Philadelphia, PA, Lippincott Williams & Wilkins, 2001, pp 1109-1207
Fung DA, Menkowitz M, Chern K. Asymmetric bilateral shoulder dislocation involving a luxatio erecta dislocation. Am J Orthop. 2008 May;37(5):E97-8. PMID:18587510 (Link to Abstract)

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