# Bilateral Anterior Shoulder Dislocations: A Narrative Review and Case Report

## TL;DR

This paper presents a rare case of bilateral anterior shoulder dislocations and reviews similar cases, emphasizing the need for thorough diagnosis and advanced imaging.

## Contribution

The paper introduces a treatment algorithm and highlights the under-recognized importance of advanced imaging in managing bilateral shoulder dislocations.

## Key findings

- Bilateral anterior shoulder dislocations are rare and often caused by seizures or high-energy trauma.
- Concomitant injuries like rotator cuff tears are common but may be under-recognized without MRI.
- Functional outcomes improve with proper management, though deficits persist with associated injuries.

## Abstract

Simultaneous bilateral anterior shoulder dislocations are extremely rare and typically result from high-energy trauma or seizure activity. Due to their unusual presentation, diagnosis and associated injuries may be missed without thorough assessment and advanced imaging. Here, we present a case report with an associated narrative review of the relevant medical literature. In addition, we propose a treatment algorithm to optimise management of this cohort.
A 44-year-old male presented to the emergency department with bilateral shoulder pain and loss of function after lifting a 100 kg weight overhead during a strongman competition. Initial radiographs confirmed bilateral anterior shoulder dislocations without associated fracture. Bilateral closed reductions were successfully performed under sedation. On follow-up, the patient reported numbness in the posterior left forearm. Bilateral shoulder MRI revealed full-thickness supraspinatus and infraspinatus tears, with a partial subscapularis tear and biceps tendon subluxation on the left. The patient was listed for staged arthroscopic rotator cuff repair, beginning with the dominant (left) shoulder.
A narrative review of 33 recent case reports was conducted. Seizure was the most common cause of bilateral dislocation, and anterior dislocations predominated. Concomitant injuries, particularly fractures and soft tissue damage, were common. However, MRI was not often used, possibly contributing to an under-reporting of rotator cuff pathology. Functional outcomes were generally good with appropriate management, although persistent deficits were more common in patients with associated injuries.
This case reinforces the importance of comprehensive clinical and radiological assessment in bilateral shoulder dislocations. Our review evaluates current imaging and management and highlights that concomitant fractures and soft tissue injury, including rotator cuff tears, are common, but may be under-recognised without advanced imaging. Our treatment algorithm advocates for a high index of suspicion and emphasises the importance of considering advanced imaging techniques in both the acute and outpatient settings.