Ballesteros Rafael, Benavente Pablo, Bonsfills Nuria, Chacón Marta, García-Lázaro Francisco J
Orthopedic Surgery Service, Universitary Hospital Fuenlabrada, Madrid, Spain.
J Emerg Med. 2013 Jan;44(1):269-79. doi: 10.1016/j.jemermed.2012.07.047. Epub 2012 Sep 29.
Although anterior shoulder dislocation is common in everyday practice in Emergency Departments, bilateral presentation is a rare entity.
The aim of this article is to report two additional cases of this rare injury and to introduce a new mechanism that can produce it. We made an exhaustive review of the literature and found 68 cases in printed publications. Also, we analyzed the mechanism of injury and the presence of predisposing factors, and propose a new etiological-mechanical classification.
One case occurred after a trivial fall, and the other was produced by a mechanism not previously reported: the patient pushed strongly forward, expecting a resistance and finding none, his arms kept the forward movement and the shoulders dislocated.
This lesion has a bimodal distribution, affecting mainly men (70%) with a mean age of 33.5 years, whereas in women, the average age is 57 years. The most common cause is trauma (50%), followed by muscle contractions (37%) due to seizures of different causes (epileptic, hypoglycemia, toxic, or hypoxic) or electrocution. In 15.7% of the cases, the diagnosis of bilateral anterior dislocation was not acute (<3 weeks), and in virtually all of these cases it was not traumatic.
The bilateral anterior shoulder dislocation may not be as rare as previously thought and must be taken into account in emergency services. The authors propose a new etiological-mechanical classification. Also, the importance of radiologic diagnosis must be highlighted.
尽管肩关节前脱位在急诊科的日常诊疗中很常见，但双侧肩关节前脱位却是一种罕见的情况。
本文旨在报告另外两例这种罕见损伤的病例，并介绍一种可能导致该损伤的新机制。我们对文献进行了详尽的回顾，在印刷出版物中发现了68例病例。此外，我们分析了损伤机制和 predisposing 因素的存在情况，并提出了一种新的病因 - 力学分类法。
一例发生在轻微跌倒后，另一例是由一种先前未报道的机制导致的：患者用力向前推，预期会有阻力但未遇到，其双臂保持向前运动，导致肩关节脱位。
这种损伤具有双峰分布，主要影响男性（70%），平均年龄为33.5岁，而女性的平均年龄为57岁。最常见的原因是创伤（50%），其次是由于不同原因（癫痫、低血糖、中毒或缺氧）的癫痫发作或触电引起的肌肉收缩（37%）。在15.7%的病例中，双侧肩关节前脱位的诊断并非急性（<3周），并且几乎所有这些病例都不是创伤性的。
双侧肩关节前脱位可能不像以前认为的那么罕见，在急诊服务中必须予以考虑。作者提出了一种新的病因 - 力学分类法。此外，必须强调放射学诊断的重要性。
