Luxatio erecta: Clinical presentation and management in the Emergency Department

doi:10.1016/j.jemermed.2004.12.016

The Journal of Emergency Medicine

Volume 29, Issue 1, July 2005, Pages 85-89

https://doi.org/10.1016/j.jemermed.2004.12.016 Get rights and content

Abstract

Luxatio erecta (inferior glenohumeral dislocation) is an uncommon type of shoulder dislocation. Early recognition and reduction is important to prevent neurovascular sequelae. We report two cases of luxatio erecta in order to describe the clinical presentation and reduction technique in the Emergency Department.

Section snippets

Case 1

A 46-year-old woman presented to the Emergency Department (ED) with a complaint of painful and locked shoulder. About 5 h before presentation, she slipped and fell on an outstretched arm. She noted shoulder pain and sudden inability to move her arm in any direction. Upon presentation to the ED, the right arm was fully abducted with the elbow flexed and the hand located just behind the head. The patient supported the right arm with the other hand. She was very uncomfortable and had severe pain

Case 2

A 78 year-old woman presented to the ED complaining of right shoulder pain and inability to lower her arm. The patient, while attempting to kill an insect on the wall, had tripped and fallen on the bed. She fell on her arm in an abducted and extended position. On admission, the arm was in a raised position above the head and could not be lowered actively or passively. The axillary fossa was empty; a mass that was considered to be the humeral head was palpated adjacent to the lateral chest wall

Discussion

Luxatio erecta is an uncommon type of shoulder dislocation. It is estimated that 0.5% of all shoulder dislocations are of this type (1). Direct or indirect loading forces to the shoulder can cause inferior glenohumeral dislocation. Most commonly the arm is in an abducted position when the extremity is forcefully hyperabducted, creating a leveraging of the proximal humeral head over the acromial process. The inferior portion of the glenohumeral capsule is then disrupted and inferior glenohumeral

Conclusion

Although the clinical presentation is dramatic and diagnosis can be easily made, luxatio erecta initially may be misdiagnosed because of its rarity. Luxatio erecta should be suspected in patients presenting to the ED with erect arm posture. One should be alert for potential associated neurovascular and musculoskeletal injuries in luxatio erecta cases. There is also a high incidence of concomitant rotator cuff injury.

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Cited by (22)

Obturator hip dislocation associated with contralateral luxatio erecta humeri: An unusual traumatic association (case report)
2024, International Journal of Surgery Case Reports
Obturator hip dislocation and luxatio erecta humeri are two extremely rare injuries. We are reporting a very rare case that involves the association of these two injuries.
We reported the case of a 34-year-old male who was a victim of a high-energy road accident. Initial examinations showed a right obturator dislocation associated with a left luxatio erecta humeri without vascular-nervous complication. Further examinations have ruled out life-threatening injuries.
A closed reduction for both joints has been performed under general anesthesia less than 6 h following the trauma. Postoperative examination showed two congruent joints. Functional treatment has been implemented. Weight-bearing was permitted after 6 weeks, and physical rehabilitation of the shoulder was initiated 3 weeks after the trauma.
Last examination (20 months after trauma) showed a painless two-joint with a full range of motion. There was no sign of shoulder instability, and radiographs showed no signs of avascular necrosis of the femoral head.
Both injuries are two rare orthopedic emergencies that require prompt diagnosis and immediate reductions.
A good outcome can be expected if functional treatment is applied after prompt closed reduction. Hence, regular monitoring is required to detect complications such as avascular necrosis of the femoral head for the hip and signs of instability for the shoulder.
Shoulder Dislocations in the Emergency Department: A Comprehensive Review of Reduction Techniques
2020, Journal of Emergency Medicine
Citation Excerpt :
Inferior dislocations are particularly unique, as traditional anterior and posterior dislocation reduction techniques are not appropriate for this type of dislocation. It is difficult to determine the exact origin of this technique, as it has been commonly used as the primary reduction technique for inferior dislocations for a long time (147–152). The patient begins in the supine position.
Shoulder dislocations are a common presentation to the emergency department and one of the most frequent types of joint dislocations. Studies have found that delays from presentation to first reduction attempt and failed attempt at initial reduction are associated with lower rates of overall reduction success.
This article reviews 26 total reduction techniques, as well as a variety of modifications to these techniques. Each technique has distinct advantages and limitations associated with its use. While there are limited data comparing specific techniques, the individual success rates of most maneuvers range from 60–100%.
It is essential for emergency physicians to be familiar with multiple different reduction techniques in case the initial reduction attempt is unsuccessful or patient-specific characteristics limit the ability to perform certain techniques. This article reviews several reduction maneuvers for shoulder dislocations, variations on these techniques, and advantages and disadvantages for each approach. It is intended to serve as a resource for those interested in expanding their knowledge of shoulder reduction techniques.
A computed tomography image of luxatio erecta
2015, Journal of Emergency Medicine
Citation Excerpt :
The shoulder must be immobilized. Follow-up is necessary for the detection of any potential rotator cuff tears that were not apparent initially (6,7). In conclusion, shoulder dislocation is frequently encountered in emergency settings.
CT and MRI manifestations of luxatio erecta humeri and a review of the literature
2015, Clinical Imaging
Citation Excerpt :
Bone injuries were also prevalent in their review, with the greater tuberosity avulsion fracture being the most common type of fracture [1]. Although less frequent, fractures of the glenoid, the acromion, the humeral head, and the body of the scapula have also been reported [1,7]. Radiographs may demonstrate the classic presentation of the dislocation, i.e., the humeral shaft parallel to the scapular spine and the humeral head at or below the inferior rim of glenoid [5].
We aimed to study luxatio erecta humeri using advanced imaging modalities.
Patients with luxatio erecta humeri and a subsequent magnetic resonance imaging (MRI) and/or computed tomography (CT) scan were included in this study.
Among 10 identified cases, we detected 2 rotator cuff, 4 labral, and 2 inferior glenohumeral ligament tears as well as 2 glenohumeral cartilage defects. We observed six comminuted displaced greater tuberosity fractures, four anterior inferior glenoid fractures, and four impaction fractures of humeral head.
This study provides detailed radiologic findings associated with luxatio erecta humeri using MRI and CT.
Bilateral luxatio erecta with greater tuberosity fracture: A case report
2013, Journal of Clinical Orthopaedics and Trauma
Bilateral shoulder dislocation with greater tuberosity fracture and luxatio erecta, both are rare by themselves, with only few reports of each. We report an unusual case of posttraumatic bilateral symmetrical shoulder dislocation involving luxatio erecta with greater tuberosity fracture in a young male. To our knowledge, this is the first case of symmetrical bilateral shoulder dislocation with greater tuberosity fracture involving luxatio erecta dislocation from Indian subcontinent.
Luxatio erecta of shoulder (eight case reports)
2008, Chirurgie de la Main
La luxation de l’épaule dans sa forme erecta est une variété rare rencontrée surtout chez le sujet jeune. Le but de notre étude est de rappeler le mécanisme de cette affection ainsi que ses caractéristiques radiocliniques et thérapeutiques. Nous rapportons huit observations de luxation de l’épaule type erecta colligées entre 1995 et 2006. Il s’agit de six hommes et deux femmes d’âge moyen de 40 ans. L’épaule gauche était luxée dans sept cas, et le mécanisme était direct chez deux patients. L’attitude de l’épaule a été typique dans tous les cas avec un membre supérieur en abduction forcée, bras en l’air et impossibilité de ramener le coude au corps. Aucun trouble vasculonerveux n’a été noté. La radiographie de l’épaule de face a objectivé une luxation inférieure de la tête humérale et un axe diaphysaire au-dessus de l’horizontale dans toutes nos observations. Le traitement a consisté en une réduction sous anesthésie générale suivie d’un bandage type Dujarier pendant trois semaines. La luxation de l’épaule type erecta constitue la forme type de la luxation inférieure, son mécanisme est une chute sur le membre supérieur en grande abduction ou antépulsion. Le diagnostic clinique est facile, confirmé par la radiographie de l’épaule de face. Le pronostic fonctionnel à long terme est excellent.
The luxatio erecta is a rare form of shoulder dislocation frequently described in young patients. The purpose of our study is to review the mechanism of this affection as well as its clinical, radiographic and therapeutic features. We also report eight cases of luxatio erecta observed between 1995 and 2006. We report six males and two females with an average age of 40 years. The left shoulder was dislocated in seven cases and a direct mechanism was reported by two patients. All of our cases presented with the typical attitude described for this dislocation; an upper limb in fixed abduction with the hand raised and inability to bring the elbow back to the body. No neurovascular injury was reported in this study. Radiographic examination showed inferior dislocation of the humeral head and the axis of the shaft above the horizontal line in all of our cases. The treatment consisted of closed reduction under general anaesthesia followed by a Dujarier's bandage for three weeks. Luxatio erecta is the commonest type of inferior dislocation. Its mechanism is a fall on the upper limb in great abduction or antepulsion. The clinical diagnosis is easy, confirmed by an anteroposterior radiograph. The functional long-term prognosis is excellent.

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: Technical Tips is coordinated by Gary M. Vilke, md, of the University of California, San Diego, San Diego, California and Richard A. Harrigan, md, and Jacob W. Ufberg, md, of Temple University, Philadelphia, Pennsylvania

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Technical tipsLuxatio erecta: Clinical presentation and management in the Emergency Department

Abstract

Section snippets

Case 1

Case 2

Discussion

Conclusion

J Emerg Med

Am J Emerg Med

Am J Emerg Med

Injury

Clinical pearlsshoulder pain

Acad Emerg Med

Technical tips
Luxatio erecta: Clinical presentation and management in the Emergency Department