Bilateral Anterior Shoulder Dislocation: A Systematic Review



1 Department of Orthopaedic Surgery, Washington University in St. Louis, MO, USA

2 Washington University School of Medicine, St. Louis, MO, USA



Objectives: To compile the existing literature on bilateral anterior shoulder dislocation (BASD) and 
analyze patient demographics, mechanisms of injury, injury characteristics, management, and outcome .
Methods: This systematic review was conducted in accordance with Preferred Reporting Items for Systematic 
review and Meta-Analyses (PRISMA) guidelines. Online databases, including Ovid Medline 1946-, 
1947-, Scopus 1960-, Cochrane Central, and were systematically queried. Studies eligible for 
inclusion were case reports or case-series, documenting BASD. Two reviewers independently screened and applied 
a set of a priori exclusion criteria to each returned study. Data were extracted, compiled, and synthesized from each 
reported case of BASD. Contingency tables/Chi-Square Analyses, T-tests, and univariate regression analyses were 
conducted to assess relationships between different variables.
Results: Eighty-one studies (87 cases of BASD) were included. Patients were 41.1 (SD± 19.5) years old and most 
were male (n=63; 72.4%). Around a quarter of patients (28.7%) had a history of epilepsy/seizures or were being 
worked-up for such. Younger males were more likely to have BASD due to a seizure or electrocution (P<0.05). 
Close to a third of cases (n=27; 31.0%) were delayed in presentation. Those sustaining seizures or electrocutions 
were more likely to be delayed in presentation (P=0.013). Most events resulted in simple dislocations that were 
closed reduced successfully. BASD resulting from seizures or electrocutions were more likely to be fracturedislocations (P=0.018); and in younger patients with fracture-dislocations, closed reduction was more often to fail or 
not be attempted (P<0.05). Median follow-up was 6 months (IQR: 3 months – 12 months). Seven patients (10.6%) 
had complications and 4 (2.3%) demonstrated recurrent instability.
Conclusion: In young males presenting with BASD without known trauma, suspicion should be high for a convulsant
event. In patients with a known seizure disorder who present with chronic bilateral shoulder or arm pain, BASD 
should be considered and work-up should be expedited to avoid misdiagnosis.
 Level of evidence: V


Main Subjects

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