Age / Sex : 30 / M

Inferior dislocation caused by avulsion fracture of the greater tubercle of the humerus (Luxatio erecta)

Discussion

Findings:

a.     Shoulder AP shows Inferior dislocation of the humerus with fracture of the greater tubercle 

b.     Shoulder CT reveals triangular bony fragment of the greater tubercle of the humerus. 

c.     MR shows 

1. Avulsion fracture of greater tubercle caused by retraction of supraspinatus

2. Tear of anterior portion of the inferior glenohumeral ligament.

3. Glenoidal avulsion of glenohumeral ligament (GAGHL)

4. Hemarthrosis.

Differential Diagnosis: 

Discussion:

When Inferior dislocation of shoulder joint occurs

•       humeral head is dislocated inferior to subcoracoid position

•       The superior aspect of the humeral head does not contact the inferior aspect of the glenoid rim

•       Less than 1% of shoulder dislocation

•       Called Luxatio erecta

•       Cause:

•       Direct axial force is applied to a fully abducted arm

•       Hyperabduction force leads to leverage of the humeral head across the acromion

•       Associated complication

•       Rupture of rotator cuff (12%)

•       Detachment of the anterior labrum, fracture of the greater tuberocity (37-80%)

•       Neurologic complication, mainly concern axillary (<60%)

•       Long term: Adhesive capsulitis, recurrent subluxation or dislocation
 

References:

 1. Connally JF. DePalma ‘s The Management of Fractures and Dislocations: An Atlas. ed 3 Philadelphia, W.B. Saunders. 1981, 622.

2. Davids RJ, Talbbott DR. Luxatio Erecta Humeri. Clin Ortho and Rel Res 1990; 252:144-148.

3. Elsayed S, Hussein A, Konyves Α, Jones GD. Bilateral Luxatio erecta humeri. Injury 2005.

4. Fery A and Somelet J. La luxation en mat de l epaule. Luxatio erecta humeri. Int Orthop 1987; 11:95.

5. Gardham GRC, Scott JE. Axillary artery occlusion with erect dislocation of the shoulder. Injury 1979; 11:55.

6. Κουvidis G, Giaourakis G, Κourakis S, Papadopoulos E, Giannakoudakis N, Κourakis J. Erect dislocation of the shoulder with brachial plexus injury. ACTA 1996; 47(3)131-134.

7. Laskin RS, Sedlin ED. luxatio erecta in infancy. Clin Orthop and Rel Res 1971; 80:126