Bilateral shoulder dislocation
A 34-year-old man with a history of recurrent dislocations of both shoulders presented with sudden excruciating pain in both arms and an inability to move either of them, after attempting to lift a weight equal to his body weight above his head in the gym. On physical examination, the patient was unable to move either shoulder, and squaring of the normal shoulder contour was observed bilaterally. Radiographs showed the anterior and inferior positions of the humeral head relative to the glenoid fossa. The patient received a diagnosis of bilateral anterior shoulder dislocation. After the patient received morphine for pain relief, the shoulder dislocations were reduced individually with the use of gentle external rotation. Anterior shoulder dislocation accounts for the majority of joint dislocations seen in the emergency department. The diagnosis of dislocation is based on a number of factors, including pain and range of movement of the afflicted joint. Asymmetry of the joint typically heralds a dislocation. When bilateral dislocation occurs, this clinical asymmetry is absent, so attention must be paid to the clinical history and physical findings.
Image source NEJM (link) Adrian M. Moughty, M.B., and Gerard O’Connor, M.B. N Engl J Med 2012; 367:e12