|Ipsilateral; Shoulder; Elbow
|The shoulder joint is the most frequently dislocated joint, closely
followed by the elbow joint . However, simultaneous dislocations
of both joints on the same limb seldom occur with only eight recorded
in English literature. Fractures of the greater tuberosity or coracoid
process can be associated with dislocations of either joints (shoulder
and elbow), but a double dislocation without other associated injury
is uncommon. This combination of injury can be easily missed if
the patient is not properly examined at initial presentation  and
hence result in a late or completely missed diagnosis of the shoulder
dislocation. A case report of an ipsilateral dislocation after enduring
minor trauma was reduced with intravenous sedation in the Accident
and Emergency department and later made a very good, complete
recovery of function.
|A 40 year old female patient presented in the Accident and
Emergency department after tripping over her cat and falling down
a flight of stairs. She had previously consumed some alcohol. The
patient complained of pain over her left elbow and shoulder joints
which she consciously immobilised and refused to move. There was no
|Plain radiographs figures 1 and 2 of her left upper limb showed
anterior dislocation of the shoulder joint and posterior dislocation of
the elbow joints without any associated fracture. Figures 3 and 4 are
post-reduction plain radiographs.
|She was given entonox (Nitrous oxide and oxygen) and intravenous
morphine in the Accident and Emergency department before both
dislocations were reduced beginning with the elbow joint.
|Figures 1 and 2, both joints were stable on reduction and she had a
long arm plaster slap with the elbow in 90° of flexion and a board arm
sling. She was discharged home the same day and reviewed two weeks
post-injury where the plaster was removed and active and passive
exercises started. At three months post-injury, she had re-acquired full
range of movement of the shoulder joint and elbow flexion (20° to 110°
[90° arc of flexion]). The patient is now working full time in her career
job and remains pain free.
|Suman was the first to report and ipsilateral dislocation of the shoulder and elbow in a 31 year-old patient who suffered a road traffic
accident under the influence of alcohol  in 1981. Since then there
have only been a couple reported; eight according to English literature.
Ipsilateral dislocations of the elbow and shoulder joint is a rare and
complex injury that can go undetected in patients who are very obese,
and in head injuries patients who will not complain of pain, or in
patients who are drunk [2-5].
|The shoulder dislocation is most often missed at initial presentation.
Upholding a high degree of suspicion following trauma to the humerus
and elbow and careful clinical examination of all joints, proximal and
distal to the dislocated joint is pivotal in certifying that an ipsilateral shoulder dislocation is not missed. In the cases of road traffic incidents
and high velocity trauma, multiple dislocations may occur and
these patients should be fully and carefully examined and if there is
dislocation, the joints proximal and distal should be radiographed .
|The mechanism of injury is not well known and difficult to define.
In most occasions, patients are unable to recall their position during the
trauma. Force transmitted through the forearm with the elbow flexed
and shoulder externally rotated may be a possible cause of dislocation
. Multiple joint dislocations may mainly occur when muscle tone is
reduced . Alcohol consumption was reported in some of the cases
[1,3,8] and interestingly may be a risk factor as with this case report.
|This injury, yet complicated, may be treated with closed reduction
under general anaesthesia with t he elbow joint reduced first to ensure
a stable distal joint to help reduce the shoulder [3,9,10]. Furthermore,
Kocher’s Manoeuvre was used on this patient. As this patient was
not obese, the diagnosis of a double dislocation was not difficult and
the reduction of the dislocation occurred without complication on
intravenous sedation. Thus, in slim patients with this type of injury,
intravenous sedation may be primarily tried before considering general
anaesthesia remembering to maintain a very high index of suspicion
for second dislocations. This patient made a very good recovery within
|(1) The patients gave informed consent prior to being included in the study;
(2) the study was authorized by the local ethical committee and was performed
in accordance with the Ethical standards of the 1964 Declaration of Helsinki as
revised in 2000.
- Cleeman E, Flatow EL (2000) Shoulder dislocations in the young patient. Orthop Clin North Am 31: 217-229.
- Ali FM, Krishnan S, Farhan MJ (1998) A case of ipsilateral shoulder and elbow dislocation: an easily missed injury. J Accid Emerg Med 15: 198.
- Suman RK (1981) Simultaneous dislocations of the shoulder and the elbow. Injury 12: 438.
- Imerci A, Kumbaraci M, Incesu M, Savran A, Karapinar L, et al. (2011) Ipsilateral simultaneous shoulder and elbow dislocation: a case report. Trauma J Emerg Med 11: 72-75.
- Inan U, Cevik AA, Omeroglu H (2008) Open humerus shaft fracture with ipsilateral anterior shoulder fracture-dislocation and posterior elbow dislocation: a case report. J Trauma 64: 1383-1386.
- Khan MR, Mirdad TM (2001) Ipsilateral dislocation of the shoulder and elbow. Saudi Med J 22: 1019-1021.
- Rosson JW (1987) Triple dislocation of the upper limb. J R Coll Surg Edinb 32: 122.
- Essoh JBS, Kodo M, Traore A, Lambin Y (2005) Ipsilateral dislocation of the shoulder and elbow: A case report, Nigerian Journal of surgical research 7: 319-320.
- Hildebrand KA, Patterson SD, King GJ (1999) Acute elbow dislocations: simple and complex. Orthop Clin North Am 30: 63-79.
- Meena S, Saini P, Rustagi G, Sharma G (2012) Ipsilateral Shoulder and elbow dislocation: a case report: Malaysian Orthop J 6: 43-45.