While doing seated behind-the-neck military presses, a young man of 22
years, experienced bilateral anterior dislocation of the shoulders. He came
into the emergency department complaining of acute bilateral shoulder stiffness
and pain. He claimed to have been performing behind-the-neck military presses
with a 108-lb (50kg) weight while being spotted by a training partner. While
performing the military presses, he suddenly felt that his shoulders were going
out of place, and lost control of the bar. Unfortunately, his training partner
was unable to prevent injury. The injured man stated that he felt immediate
pain and lost mobility of his arms. He was then rushed to the emergency
department.
When the patient first arrived at the emergency department, his shoulders were
in abduction and external rotation. He complained of stiffness and pain. Tests
showed bilateral flattened contour of the shoulders below the tip of the
acromion. Anterior fullness was present, but luckily, the patient did not
suffer from any neurological or vascular injuries. Further examinations showed
a bilateral anterior shoulder dislocation but no fracture.
The young man was a 22-year-old, right-handed accountant, who had 3 years of
weight training experience. He was 5 ft 10 in. (178 cm) tall and approximately
180 lb (83.3 kg). Upon investigation, the patient had no history of any type of
injury to either of his shoulders. None of his family had any history of hyper
laxity disorders, epilepsy, or convulsions as well. He had also had no alcohol
within 24 hours of his weight training session.
The patient was treated with 10 mg of intravenous diazepam before reduction was
achieved through Kocher’s maneuver. Radiological examinations taken after
treatment showed that reduction was successful. Reduction was performed by
treating the patient with a bilateral body bandage for 3 weeks. Weekly checkups
took place through his regular physicians. However, the patient underwent 6
weeks of physical therapy after the bilateral body bandages were removed. The
patient discontinued regular weight lifting and regained full shoulder range of
motion 6 months after the initial occurrence. A follow-up 5 years later
reported no redislocation.
Many shoulder intensive sports such as baseball, tennis, and volleyball have
been responsible for many cases of symptomatic occult glenohumeral instability.
These sports often force the shoulder into an abnormal position of abduction
and external rotation, the same position required in the seated behind-the-neck
military presses performed by the patient mentioned above. Repetition of this
forceful abduction and external rotation technique adds more pressure at the
end of the extended lever arm thereby resulting in instability or even
dislocation. The joint is vulnerable to dislocation due its stability being
largely dependent on the strength and integrity of the surrounding soft
tissues.
However, bilateral simultaneous dislocation of the shoulders is quite uncommon.
Most cases are posterior and usually occur due to drug-induced seizures,
electroconvulsive therapy, or in patients with neuromuscular deficiencies or
severe emotional disturbances (psychogenic dislocation). Cases reported as
anterior most often occurred in patients who have epileptic seizures,
drug-induced seizures, or diabetic nocturnal hypoglycemia, and in patients who
have loose joints and dislocate shoulders while performing voluntary movements
or experiencing trauma. Some cases have been reported as occurring in weight
lifters.
Anterior dislocation of the shoulder most often occurs when extension,
abduction, or external rotation is forced on the arm, which then levers the
humeral head out of the glenoid fossa. Some cases indicate that a direct blow on
the posterior aspect of the shoulder or direct forward traction can cause
dislocation.