A 67 y.o. woman presented to the ED after a fall with a painful shoulder
what do you notice on her xray?
Our patient had luxatio erecta which translated from the Latin means erect dislocation. This is an appropriate name since the patient presents with a raised arm despite the dislocation. The humeral head is inferior and anterior to the glenoid. It occurs in 1 in 200 shoulder dislocations. More than half of all cases have a neurologic injury( commonly the axillary nerve) but most resolve spontaneously in six months.
luxatio erecta
Shoulder dislocations in general , are the most common of all major joint dislocations. Anterior dislocation is most common at 95-97%, posterior dislocation accounts for 2 to 4 % and inferior dislocation (luxatio erecta) for 0.5%. About half the dislocations occur during sporting events.
While there are many methods of reducing the anterior shoulder dislocation, none has proven superior. Scapular rotation, external rotation with traction, and traction countertraction are the most frequently used.
While anterior dislocations are the most common. Posterior dislocations are the hardest to see on xray without a Y view. The classic description is that the humeral head looks like a “lightbulb” because the arm is adducted and internally rotated. A scapular “Y” view confirms the diagnosis.
The posterior dislocation is difficult to reduce if there is an articular surface defect of greater than 25%. Closed reduction can be performed using axial traction on the adducted arm with the elbow flexed. The arm is internally rotated and adducted.
Reduction of the inferior dislocation can be relatively easy or quite difficult depending on the ligamentous injury accompanying it. One of the first things to try is direct upward traction. Pull upward traction while pushing the humeral head up and this may release it. If this is unsuccessful, a two step method is outlined below.
FUN FACT: The most frequent shoulder dislocations occur in basketball (24%) followed by football (21%).
Nho S, Dodson C, Bardzik K, Brophy R, et al. The two-step maneuver for closed reduction of inferior glenohumeral dislocation (luxatio erecta) to anterior dislocation to reduction) J Orhtop Traum. 2006 May; 20(5):354-7.
Rockwood C, Wirth M. Subluxation and dislocations about the glenohumeral joint In:Rrockwood C, Green D, Bucholz R. et al. eds. Fractures in Aults Philadelphia. Lippincott-Raven; 1996;1193-1339
. https://www.youtube.com/watch?v=k_ORI51luFI
Sherman S. Shoulder dislocation and reduction UpToDate Oct 2023. .
Kozok J, Whitlock K, )’Donnell J, et al. shoulder dislocations among high school aged and college aged athletes in the US : an epidemiological analysis. JSES International Vol 5(6) 2021, 967-971.