MANUAL MINORS
Luxatio erecta is an extremely rare inferior shoulder dislocation, in which the humeral head is displaced downward, out of the glenoid cavity of the scapula. This injury typically results from extreme hyperabduction of the arm, where the humerus is forced upward and out of the joint. It is a severe condition often associated with damage to neurovascular structures, such as the brachial plexus and axillary artery, requiring immediate medical attention.
Diagnosis
The diagnosis is evident by the characteristic arm position: the patient presents with the arm elevated, fully abducted, and positioned above the head, as if permanently raising the arm.
In addition to intense pain and the inability to move the arm, a visible shoulder deformity is often observed. Anteroposterior and axillary X-rays of the shoulder confirm the inferior dislocation of the humeral head, which appears below the glenoid cavity.
Differential Diagnosis
Pathology | Characteristics |
|---|---|
Anterior shoulder dislocation | Arm in abduction and external rotation, with visible anterior shoulder deformity |
Posterior shoulder dislocation | Arm in adduction and internal rotation, with less obvious deformity |
Humeral neck fracture | Shoulder deformity without complete loss of joint contact |
Rotator cuff tear | Shoulder pain and weakness, without dislocation or deformity |
Brachial plexus injury | Arm pain and weakness, but without bone displacement |
Emergency Management
Emergency management involves urgent reduction of the dislocation to prevent further damage to nerves and blood vessels. Reduction is typically performed under sedation or anaesthesia, using gentle traction techniques to reposition the humeral head into the glenoid cavity.
After reduction, it is crucial to assess neurovascular function, focusing on the brachial plexus and axillary artery, which may have been compromised. Post-reduction X-rays are necessary to confirm proper alignment and rule out associated fractures.
Definitive Treatment
Definitive treatment depends on shoulder stability after reduction and the presence of associated injuries. After successful reduction, the shoulder is immobilised with a sling or splint for 2 to 4 weeks, followed by physiotherapy to restore range of motion and strength.
In cases of persistent instability or significant soft tissue damage, surgical repair may be necessary, such as labrum or ligament stabilisation. Rehabilitation is essential to prevent recurrent dislocations and restore full shoulder function.
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