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 (50 kg) 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).
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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 re dislocation. 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, electro convulsive 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.
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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.
