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Arthroscopic Treatment of Luxatio Erecta Humeri Associated with Greater Tuberosity Fracture, Bankart Lesion, and Partial Rotator Cuff Tear: A Case Report

Challenging differential diagnosis, Unusual or unexpected effect of treatment, Rare coexistence of disease or pathology

Antonis Kouzelis, Zinon T. Kokkalis, Ioannis Lachanas, Charalampos Matzaroglou, Aikaterini Solomou, Andreas Panagopoulos

Greece Department of Orthopaedics, University Hospital, Patras Medical School, Patras, Greece

Am J Case Rep 2020; 21:e923727

DOI: 10.12659/AJCR.923727

Available online: 2020-05-13

Published: 2020-06-18


#923727

BACKGROUND: Luxatio erecta humeri (LEH) is a rare injury present in only 0.5% of shoulder dislocations. Much of the relevant literature is focused on the initial management and proper reduction techniques, although the prevalence of associated injuries can reach 80%. A case of LEH associated with greater tuberosity (GT) fracture and rotator cuff (RC) tear in a young laborer managed with closed reduction and arthroscopic repair of the labrum and rotator cuff is presented.
CASE REPORT: A 28-year-old man presented to our hospital with severe pain in his right shoulder after a high-impact motor vehicle accident. Standard anteroposterior radiographs revealed an inferior dislocation (LEH) of the right shoulder and a fracture of the GT. The patient was initially managed with closed reduction under mild intravenous sedation, using a 2-step maneuver followed by arthroscopic evaluation of the joint the next day. During arthroscopic evaluation, an anterior-inferior Bankart lesion, impaction of the humeral head with a minimal displaced GT fracture, and a partial RC tear were identified and successfully treated arthroscopically. The patient had immobilization in a simple sling for 6 weeks and he followed a standard 3-month physiotherapy protocol for rotator cuff, finally regaining almost normal range of shoulder motion at 1 year.
CONCLUSIONS: Although very good results of non-operative treatment of LEH have been reported in the literature, the co-existence of intra-articular lesions such as labral and rotator cuff tears makes arthroscopic repair an attractive alternative in individual cases.

Keywords: rotator cuff, Shoulder Dislocation, Shoulder Fractures



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