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Luxatio Erecta S43.036A 831.03

inferior shoulder dislocation
ICD-9 Classification / Treatment
Etiology / Epidemiology / Natural History Associated Injuries / Differential Diagnosis
Anatomy Complications
Clinical Evaluation Follow-up Care
Xray / Diagnositc Tests Review References

 

synonyms: inferior shoulder dislocation 

Luxatio Erecta ICD-10

A- initial encounter

D- subsequent encounter

S- sequela

Luxatio Erecta ICD-9

  • 831.03(inferior)
  • 718.81 (instability of shoulder joint)

Luxatio Erecta Etiology / Epidemiology / Natural History

  • Rare, may be as low as 0.5% of all shoulder dislocations
  • Generally occurs from a hyperabduction force or axial loading on the abducted arm.
  • Commonly reported bilaterally. (Numerous case reports)

Luxatio Erecta Anatomy

  • Glenohumeral stability is dependent on static (labrum, GH capular ligmants) and dynamic (RTC, deltoid, biceps, scapular musculature) restraints.
  • Inferior glenohumeral ligament (consist of anterior inferior GH ligamant, axillary pouch and posterior inferior GH ligament) is the most important for resisting anterior translation in the abducted arm.
  • See also Shoulder anatomy.

Luxatio Erecta Clinical Evaluation

  • Inferior dislocation: arm is generally locked in an overhead position; horizontally abducted.
  • Evaluate for axillary nerve function. Humeral head may compress the axillary nerve.
  • Complete UE neurovascular exam, include brachial, radial and ulnar pulses.

Luxatio Erecta Xray / Diagnositc Tests

  • A/P, and Lateral in the plane of the scapula, and axillary view. Closely evaluate for concomitant surgical neck or other fracture.
  • Arteriography or other vascular study is frequenty indicated due to high association of inferior dislocations with axillary vessel injury.
  • MRI: consider it evaluated labral intergrity after reduction.
  • CT: helpful if bony lesions of the glenoid or humeral head are suspected.

Luxatio Erecta Classification / Treatment

  • Ensure mechanism is consistant with inferior dislocation. Axillary nerve palsy, deltoid/RTC atony after shoulder trauma/surgery may cause inferior GH subluxation which will resolve with simple observation. (Pritchett JW, JSES 1997;6:356).
  • Traumatic inferior dislocation: closed reduction, document neurovascular status before and after reduction. Reduction generally performed with appropriate sedation and traction-countertraction.
  • Consider arteriogram.

Luxatio Erecta Associated Injuries / Differential Diagnosis

  • Axillary nerve palsy
  • Greater tuberosity fracture
  • Bankart lesion:
  • Capsular tear:
  • HAGL lesion.
  • Proximal humerus fracture.
  • Coracoid Fracture
  • Rotator cuff tear:
  • SLAP
  • Anterior Glenohumeral Instability
  • Posterior Glenohumeral Instability
  • Axillary nerve palsy / Deltoid atony (may cause inferior GH subluxation)

Luxatio Erecta Complications

  • HAGL
  • Axillary nerve palsy
  • Brachial plexus palsy
  • Axillary artery injury
  • Osteonecrosis: rare; generally associated with fracture-dislocations. Best treated with observation in adolescents (Pateder DB, JBJS 2004;86A:2290).
  • Recurrent instability:

Luxatio Erecta Follow-up Care

Luxatio Erecta Review References

  • Middeldorpf M, Scharm B. De nova humeri luxationis specie. Clin Eur. 1859;2:12-116.
  • Davids J, Talbott R. Luxatio erecta humeri: a case report. Clin Orthop Relat Res. 1990;252:144-149.
  • Mallon W, Basset F, Goldner R. Luxatio erecta: the inferior glenohumeral dislocation. J Orthop Trauma. 1990;4:19-24.
  • Schai P, Hinterman B. Arthroscopic findings in luxatio erecta of the glenohumeral joint: a case report and review of literature. Clin J Sports Med. 1998;8:138-141.
  • Laskin RS, Sedlin ED. Luxatio erecta in infancy. Clin Orthop Relat Res. 1971;80:126–129.
  • Foad A, LaPrade RF. Bilateral luxatio erecta humeri and bilateral knee dislocations in the same patient. Am J Orthop. 2007;36:611–613.
  • Kumar KS, O’Rourke S, Pillay JG. Hands up: a case of bilateral inferior shoulder dislocation. Emerg Med J. 2001;18:404–405.
  • Garcia R, Ponsky T, Brody F, et al. Bilateral luxatio erecta complicated by venous thrombosis. J Trauma. 2006;60:1132–1134.
  • Sewecke JJ, Varitimidis SE. Bilateral luxatio erecta: a case report and review of the literature. Am J Orthop. 2006;35:578–580.
  • Shane JN, Christopher CD, Katherine FB, et al. The two-step maneuver for closed reduction of inferior glenohumeral dislocation (luxatio erecta to anterior dislocation to reduction). J Orthop Trauma. 2006;20:354–357.
  • Gardham JR, Scott JE. Axillary artery occlusion with erect dislocation of the shoulder. Injury. 1980;11:155–158.
  • Lev-El A, Adar R, Rubinstein Z. Axillary artery injury in erect dislocation of the shoulder. J Trauma. 1981;21:323–325.