Bilateral Anterior Shoulder Dislocation: A Systematic Review

Document Type : SYSTEMATIC REVIEW

Authors

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

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

Abstract

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-, Embase.com 
1947-, Scopus 1960-, Cochrane Central, and Clinicaltrials.gov 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

Keywords

Main Subjects


  1. Blake R, Hoffman J. Emergency department evaluation and 
    treatment of the shoulder and humerus. Emerg Med Clin North 
    Am. 1999; 17(4):859-76. doi:10.1016/s0733-8627(05)70101-2.
    2. Yang NP, Chen HC, Phan DV, et al. Epidemiological survey of 
    orthopedic joint dislocations based on nationwide insurance data 
    in Taiwan, 2000-2005. BMC Musculoskelet Disord. 2011; 12:253. 
    doi:10.1186/1471-2474-12-253.
    3. Wilk KE, Arrigo CA, Andrews JR. Current concepts: the stabilizing
    structures of the glenohumeral joint. J Orthop Sports Phys Ther. 
    1997; 25(6):364-79. doi:10.2519/jospt.1997.25.6.364.
    4. Turkel SJ, Panio MW, Marshall JL, Girgis FG. Stabilizing 
    mechanisms preventing anterior dislocation of the glenohumeral 
    joint. J Bone Joint Surg Am. 1981; 63(8):1208-17. 
    5. Gasbarro G, Bondow B, Debski R. Clinical anatomy and stabilizers 
    of the glenohumeral joint. Annals of Joint. 2017; 2(58).
    6. Sheehan SE, Gaviola G, Sacks A, Gordon R, Shi LL, Smith SE. 
    Traumatic shoulder injuries: a force mechanism analysis of 
    complex injuries to the shoulder girdle and proximal humerus. 
    AJR Am J Roentgenol. 2013; 201(3):W409-24. 
    doi:10.2214/AJR.12.9987.
    7. Whiting WC, Zernicke RF. Biomechanics of musculoskeletal 
    injury. 2nd ed. Human Kinetics. 2008.
    8. Lippitt S, Matsen F. Mechanisms of glenohumeral joint stability. 
    Clin Orthop Relat Res. 1993 ;( 291):20-8.
    9. Warner JJ, Caborn DN, Berger R, Fu FH, Seel M. Dynamic 
    capsuloligamentous anatomy of the glenohumeral joint. J 
    Shoulder Elbow Surg. 1993; 2(3):115-33. doi:10.1016/S1058-
    2746(09)80048-7.
    10. Zacchilli MA, Owens BD. Epidemiology of shoulder dislocations 
    presenting to emergency departments in the United States. J 
    Bone Joint Surg Am. 2010;92(3):542-9. doi:10.2106/JBJS.I.00450.
    11. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 
    statement: an updated guideline for reporting systematic 
    reviews. BMJ. 2021; 372:n71. doi:10.1136/bmj.n71
    12. Abdulkadir AY, Adesiyun OA, Jimoh OR, Amole AO. Chronic 
    bilateral anterior shoulder dislocation. S Afr Med J. 2009; 
    99(5):313. 
    13. Agrahari Y, Agrahari MJL, Kunwor SK. Simultaneous Bilateral 
    Anterior Glenohumeral Joint Dislocation: A Case Report. JNMA J 
    Nepal Med Assoc. 2020; 58(227):512-514. 
    doi:10.31729/jnma.4949.
    14. Ahmad K, Ayaz SB, Khalil HB, Matee S. Bilateral spontaneous 
    anterior shoulder dislocation: A missed orthopedic injury 
    mistaken as proximal neuropathy. Chin J Traumatol. 2017; 
    20(6):370-372. doi:10.1016/j.cjtee.2017.06.003.
    15. Antri IE, Benyass Y, Zine A. Simultaneous bilateral anterior 
    shoulder dislocation as a result of minimal trauma. Pan Afr Med J. 
    2020; 36:94. doi:10.11604/pamj.2020.36.94.23757.
    16. Auerbach B, Bitterman A, Mathew C, Healy W. Bilateral Shoulder 
    Dislocation Presenting as a Unilateral Shoulder Dislocation: Case 
    Report. J Am Osteopath Assoc. 2015; 115(8):514-517. 
    doi:doi:10.7556/jaoa.2015.106. 17. Ballesteros R, Benavente P, Bonsfills N, Chacón M, García-Lázaro 
    FJ. Bilateral Anterior Dislocation of the Shoulder: Review of 
    Seventy Cases and Proposal of a New Etiological-mechanical
    Classification. J Emerg Med. 2013; 44(1):269-279. 
    doi:10.1016/j.jemermed.2012.07.047
    18. Bellazzini MA, Deming DA. Bilateral anterior shoulder dislocation 
    in a young and healthy man without obvious cause. Am J Emerg 
    Med. 2007; 25(6):734.e1-734.e3. 
    doi:10.1016/j.ajem.2006.12.018.
    19. Bremner LF, Dewing CB, McDonald LS, Provencher MT. 
    Simultaneous Bilateral Anterior Shoulder Fracture Dislocation 
    Following a Seizure: A Case Report. Military Medicine. 2013; 
    178(3):e400-e403. doi:10.7205/milmed-d-12-00378.
    20. Chamseddine A, Mouchantaf ME, Freiha K, Asfour A, Boushnak 
    MO. Missed Bilateral Anterior Shoulder Dislocation with Bilateral 
    Coracoid Fracture and Unilateral Long Head of Biceps Rupture. 
    Cureus. 2020;doi:10.7759/cureus.10996.
    21. Chen C-L, Chiu S-L, Chu C-L, Lan S-J. Tragic result of traditional 
    Chinese medicine manipulation: an unusual case report of 
    bilateral anterior shoulder dislocations. BMC Complement Altern 
    Med. 2015; 15(1) doi: 10.1186/s12906-015-0633-4.
    22. Chen KL, Liu SY, Wei TS. Bilateral anterior shoulder dislocation as 
    a result of manipulation: A case report. Medicine (Baltimore). 
    2017; 96(49):e8590. doi:10.1097/MD.0000000000008590.
    23. Choulapalle R, Chokkarapu R, Kolluri RK, et al. A Case of 
    Neglected Bilateral Anterior Shoulder Dislocation: A Rare Entity 
    with Unusual Mechanism of Injury. Case Rep Orthop. 2015; 
    2015:1-3. doi:10.1155/2015/461910.
    24. Costigan PS, Binns MS, Wallace WA. Undiagnosed bilateral 
    anterior dislocation of the shoulder. Injury. 1990; 21(6):409. 
    doi:10.1016/0020-1383(90)90134-g.
    25. Cottias P, Bellec YL, Jeanrot C, Imbert P, Huten D, Masmejean EH. 
    Fractured coracoid with anterior shoulder dislocation and 
    greater tuberosity fracture--report of a bilateral case. Acta 
    Orthop Scand. 2000; 71(1):95-97. 
    doi:10.1080/00016470052943982.
    26. Cresswell TR, Smith RB. Bilateral anterior shoulder dislocations 
    in bench pressing: an unusual cause. Br J Sports Med. 1998; 
    32(1):71-72. doi:10.1136/bjsm.32.1.71.
    27. Deshpande S, Samal N, Gawande V, Rathi R. Bilateral anterior 
    fracture dislocation of shoulder-A rare case. Article. Journal of 
    Krishna Institute of Medical Sciences University. 2014; 3(1):112-
    115. 
    28. Devalia KL, Peter VK. Bilateral post traumatic anterior shoulder 
    dislocation. J Postgrad Med. 2005; 51(1):72-3. 
    29. Diallo M, Soulama M, Kaboré DSR, Dakouré PWH, Liverneaux P. 
    Bilateral anterior shoulder dislocations: A review of two cases 
    and the relevant literature. Clin Case Rep. 2020; 8(12):3379-
    3388. doi:10.1002/ccr3.3351.
    30. Dinopoulos HT, Giannoudis PV, Smith RM, Matthews SJ. Bilateral 
    anterior shoulder fracture-dislocation. Int Orthop. 1999; 
    23(2):128-130. doi:10.1007/s002640050327.
    31. Dlimi F, Mahfoud M, Lahlou A, El Bardouni A, Berrada MS, El 
    Yaacoubi M. Bilateral anterior shoulder dislocation with bilateral 
    fractures of the greater tuberosity: A case report. J Clin Orthop 
    Trauma. 2012; 3(2):122-125. doi:10.1016/j.jcot.2011.04.001.
    32. Dlimi F, Rhanim A, Lahlou A, et al. Bilateral anterior dislocation of 
    the shoulders at the start of a backstroke competition. J Orthop 
    Traumatol. 2012; 13(1):47-49. doi:10.1007/s10195-011-0176-5.
    33. Dodds SD, Medvecky MJ. Chronic bilateral locked anterior 
    shoulder fracture-dislocations. Am J Orthop (Belle Mead NJ). 
    2008; 37(7):364-8.
    34. Dunlop CCR. Bilateral anterior shoulder dislocation A case report 
    and review of the literature. Article. Acta Orthopaedica Belgica. 
    2002; 68(2):168-170. 
    35. El Rassi G, Hijjawi A, Matta J, Fahs S, Khair OA. Bilateral locked 
    anterior shoulder dislocation in a bench-pressing athlete: case 
    report. Arch Orthop Trauma Surg. 2015; 135(6):747-749. 
    doi:10.1007/s00402-015-2182-1.
    36. Esenkaya I, Tuygun H, Türkmen IM. Bilateral anterior shoulder 
    dislocation in a weight lifter. Phys Sportsmed. 2000; 28(3):93-
    100. doi:10.3810/psm.2000.03.782.
    37. Felderman H, Shih R, Maroun V. Chin-up-induced bilateral 
    anterior shoulder dislocation: a case report. J Emerg Med. 2009; 
    37(4):400-2. doi:10.1016/j.jemermed.2008.06.001.
    38. Gopinath NR, Prabhakar R, Puneeth K, Sudheer M. Neglected 
    bilateral anterior fracture dislocation shoulder: A rare case 
    report. Article. Journal International Medical Sciences Academy. 
    2016; 29(3):153-154. 
    39. Hartney-Velazco K, Velazco A, Fleming LL. Bilateral anterior 
    dislocation of the shoulder. Article. South Med J. 1984; 
    77(10):1340-1341. doi: 10.1097/00007611-198410000-00040. 
    40. Jones M. Bilateral anterior dislocation of the shoulders due to the 
    bench press. Br J Sports Med. 1987; 21(3):139-139. 
    doi:10.1136/bjsm.21.3.139.
    41. Joseph J, Nguyen N, Gruzman D, Boutin A, Olsen D. No Sweat! 
    Bilateral Shoulder Reduction Using a Modified Davos Technique. 
    Clin Pract Cases Emerg Med. 2019; 3(1):40-42. 
    doi:10.5811/cpcem.2018.11.39445.
    42. Kakhki BR, Torghabeh JT, Gharaee AM, Doluee MT. Bilateral 
    anterior shoulder dislocation due to seizure in a twenty-one 
    year-old man. Article. Razavi International Journal of Medicine. 
    2015; 3(2) doi:10.5812/rijm.3 (2)2015.25742.
    43. Kalkan T, Demirkale I, Ocguder A, Unlu S, Bozkurt M. Bilateral 
    anterior shoulder dislocation in two cases due to housework 
    accidents. Acta Orthop Traumatol Turc. 2009; 43(3):260-3. 
    doi:10.3944/aott.2009.260.
    44. Karaman İ, Ekinci Y, Kafadar İH, Yurdakul E. Non-traumatic 
    bilateral anterior shoulder dislocation. Article. Erciyes Tip 
    Dergisi. 2015; 37(4):151-153. doi:10.5152/etd.2015.8494.
    45. Kovilazhikathu Sugathan H, Radha S, Harrison JWK. Chronic 
    bilateral anterior shoulder dislocation-case report and review of 
    literature. Article. European Orthopaedics and Traumatology. 
    2012; 3(4):227-229. doi:10.1007/s12570-012-0132-8.
    46. Kubiak G, Fabiś J. Clinical improvement after 2 years one stage 
    bilateral open reduction of chronic anterior shoulder dislocations 
    with internal fixation of greater tuberosity fractures. Case study. 
    Ortop Traumatol Rehabil. 2013; 15(2):175-181. 
    doi:10.5604/15093492.1045952.
    47. Kumar YC, Nalini KB, Maini L, Nagaraj P. Bilateral Traumatic 
    Anterior Dislocation of Shoulder - A Rare Entity. J Orthop Case 
    Rep. 2013; 3(1):23-25. 
    48. Lasanianos N, Mouzopoulos G. An undiagnosed bilateral anterior 
    shoulder dislocation after a seizure: a case report. Cases J. 2008; 
    1(1):342. doi:10.1186/1757-1626-1-342.
    49. Litchfield JC, Subhedar VY, Beevers DG, Patel HT. Bilateral 
    dislocation of the shoulders due to nocturnal hypoglycaemia. 
    Postgrad Med J. 1988; 64(752):450-452. 
    doi:10.1136/pgmj.64.752.450.
    50. Madi S, Pandey V, Acharya K, Peruvaje Ramakrishna KP. A rare 
    injury to a rear seat passenger: bilateral fracture dislocation of 
    the shoulders. BMJ Case Rep. 2015:2015:bcr2015209992b. 
    doi:10.1136/bcr-2015-209992.
    51. Maffulli N, Mikhail HM. Bilateral anterior glenohumeral 
    dislocation in a weight lifter. Injury. 1990; 21(4):254-6. 
    doi:10.1016/0020-1383(90)90020-u. 52. Manoharan G, Singh R, Ahmed B, Kathuria V. Acute spontaneous 
    atraumatic bilateral anterior dislocation of the shoulder joint 
    with Hill-Sachs lesions: first reported case and review of 
    literature. BMJ Case Rep.2014:2014:bcr2013202847. 
    doi:10.1136/bcr-2013-202847.
    53. Martin AN, Tsekes D, White WJ, Rossouw D. Chloroquine-induced 
    bilateral anterior shoulder dislocation: a unique aetiology for a 
    rare clinical problem. BMJ Case Rep. 2016:bcr2015214292. 
    doi:10.1136/bcr-2015-214292.
    54. Martínez ÁA, Herrero L, Herrera A. Bilateral anterior shoulder 
    dislocation due to electric shock. European Journal of 
    Orthopaedic Surgery & Traumatology. 2001; 11(2):121-122. 
    doi:10.1007/bf01682490.
    55. McFie J. Bilateral anterior dislocation of the shoulders: a case 
    report. Injury. 1976; 8(1):67-9. doi:10.1016/0020-
    1383(76)90014-0.
    56. Meena S, Saini P, Singh V, Kumar R, Trikha V. Bilateral anterior 
    shoulder dislocation. J Nat Sci Biol Med. 2013; 4(2):499-501. 
    doi:10.4103/0976-9668.117003.
    57. Mehta MP, Kottamasu SR. Anterior dislocation of the shoulders 
    with bilateral brachial plexus injury. Ann Emerg Med. 1989;
    18(5):589-91. doi:10.1016/s0196-0644(89)80850-9.
    58. Mofidi M, Kianmehr N, Farsi D, Yazdanpanah R, Majidinezhad S, 
    Asadi P. An unusual case of bilateral anterior shoulder and 
    mandible dislocations. Am J Emerg Med. 2010; 28(6):745.e1-
    745.e2. doi:10.1016/j.ajem.2009.09.024.
    59. Nagi ON, Dhillon MS. Bilateral anterior fracture dislocation of the 
    shoulders. J Orthop Trauma. 1990; 4(1):93-5. 
    doi:10.1097/00005131-199003000-00016.
    60. Ng AB, Rix TE, Roy BR. Acute bilateral anterior dislocations of the 
    shoulders. Ulster Med J. 2000; 69(2):171-172.
    61. Ngim NE, Udorroh EG, Udosen AM. Acute bilateral anterior 
    shoulder dislocation following domestic assault – case report. 
    West Afr J Med. 2007; 25(3) doi:10.4314/wajm.v25i3.28292.
    62. Nourredine H, El Sayad M, Gull S, Davies AP. Bilateral anterior 
    shoulder dislocation. BMJ Case Rep.2013:2013:bcr2012008308. 
    doi:10.1136/bcr-2012-008308.
    63. O'Connor-Read L, Bloch B, Brownlow H. A missed orthopaedic 
    injury following a seizure: a case report. J Med Case Rep. 2007; 
    1(1):20. doi:10.1186/1752-1947-1-20.
    64. Özçelik A, Dinçer M, Çetinkanat H. Recurrent bilateral dislocation 
    of the shoulders due to nocturnal hypoglycemia: A case report. 
    Diabetes Res Clin Pract. 2006; 71(3):353-355. 
    doi:10.1016/j.diabres.2005.07.006.
    65. Park TD, Enyart JM, Goyke TE, Greenberg MR. An unusual case of 
    bilateral anterior shoulder dislocations. Radiol Case Rep. 2018; 
    13(1):197-199. doi:10.1016/j.radcr.2017.09.030.
    66. Poggetti A, Castellini I, Neri E, Marchettil S, Lisanti M. Atraumatic 
    Bilateral Neglected Anterior Shoulder Dislocation: Case Report of 
    a Jehovah's Witness 28-Year-Old Male Affected by IronDeficiency Anemia and Treated with Bilateral Latarjet Procedure. 
    J Orthop Case Rep. 2015; 5(3):81-3. doi:10.13107/jocr.2250-
    0685.317.
    67. Porecha MM, Parmar DS. Bilateral anterior fracture-dislocation 
    shoulder: a case report with a review of the literature. European 
    Journal of Orthopaedic Surgery & Traumatology. 2011; 21(1):43-
    46. doi:10.1007/s00590-010-0658-9.
    68. Raptis K, Koutserimpas C, Alpantaki K, Kaiafas S, Fandridis E, 
    Bourlos D. Neglected Bilateral Anterior Shoulder Dislocation 
    Following Epileptic Seizure: A Case Report and Literature 
    Review. Kurume Med J. 2019; 66(1):65-70. 
    doi:10.2739/kurumemedj.ms661008.
    69. Rouhani A, Zonooz KA, Aghdam A. An unusual cause of bilateral 
    anterior shoulder dislocation. Clinical report. Pakistan Journal of 
    Medical Sciences. 2010; 26(4).
    70. Rudy BS, Hennrikus WL. Bilateral anterior shoulder dislocation. 
    JAAPA. 2017; 30(7):25-27. 
    doi:10.1097/01.JAA.0000515543.89945.e5.
    71. Sachit M, Shekhar A, Shekhar S, Joban SH. Acute spontaneous 
    atraumatic bilateral anterior dislocation of the shoulder joint 
    with Hill-Sach's lesions: A rare case. J Orthop Case Rep. 2015; 
    5(1):55-57. doi:10.13107/jocr.2250-0685.256.
    72. Salem MI. Bilateral anterior fracture-dislocation of the shoulder 
    joints due to severe electric shock. Injury. 1983; 14(4):361-363. 
    doi:10.1016/0020-1383(83)90258-9.
    73. Schneider KN, Schliemann B, Manz SM, Buddhdev PK,
    Ahlbäumeri G. Bilateral Anterior Shoulder Dislocation in the 
    Elderly - A Case Report and Review of the Literature. J Orthop 
    Case Rep. 2017; 7(5):42-49. doi:10.13107/jocr.2250-0685.890.
    74. Segal D, Yablon IG, Lynch JJ, Jones RP. Acute bilateral anterior 
    dislocation of the shoulders. Clin Orthop Relat Res. 1979 ;( 
    140):21-2. 
    75. Sharma L, Pankaj A, Kumar V, Malhotra R, Bhan S. Bilateral 
    Anterior Dislocation of the Shoulders with Proximal Humeral 
    Fractures: A Case Report. J Orthop Surg (Hong Kong). 2005; 
    13(3):303-306. doi:10.1177/230949900501300316.
    76. Shetty SK, Mathias LJ, Rai HR, Babu PN, R RSN, C VK. 
    Simultaneous Bilateral Anterior Dislocation of the Shoulder with 
    Fractures of the Greater Tuberosity Following Trauma- A Case 
    Report. Journal of Health and Allied Sciences NU. 2014; 
    04(01):129-130. doi:10.1055/s-0040-1703750.
    77. Silva LP, Sousa CV, Rodrigues E, Alpoim B, Leal M. Bilateral 
    Anterior Glenohumeral Dislocation: Clinical Case. Revista 
    Brasileira de Ortopedia (English Edition). 2011; 46(3):318-320. 
    doi:10.1016/s2255-4971(15)30203-2.
    78. Singh S, Kumar S. Bilateral anterior shoulder dislocation: a case 
    report. Eur J Emerg Med. 2005; 12(1):33-5. 
    doi:10.1097/00063110-200502000-00009.
    79. Siu YC, Lui TH. Bilateral Anterior Shoulder Dislocation. Arch 
    Trauma Res. 2014; 3(4) doi:10.5812/atr.18178.
    80. Siwach R, Singh R, Rohilla R. Bilateral anterior dislocation of the 
    shoulder—A case report and review of the literature. Injury 
    Extra. 2008; 39:394–397. doi:10.1016/j.injury.2008.08.040.
    81. Sunku N, Kalaiah K, Marulasidappa G, Gopinath P. Bilateral 
    Anterior Fracture-Dislocation of Shoulder Joint- A rare case with 
    Delayed Presentation. J Orthop Case Rep. 2012; 2(4):7-9. 
    82. Suryavanshi A, Mittal A, Dongre S, Kashyap N. Bilateral Anterior 
    Shoulder Dislocation with Symmetrical Greater Tuberosity 
    Fracture following Seizure. J Orthop Case Rep. 2012; 2(1):28-31. 
    83. Taneja AK, Pecci Neto L, Skaf A. Bilateral anterior glenohumeral 
    dislocation and coracoid processes fracture after seizure: acute 
    MRI findings of this rare association. Clin Imaging. 2013; 
    37(6):1131-4. doi:10.1016/j.clinimag.2013.08.007.
    84. Thakur A, Gupta R, Kotwal V, Arora D. A rare case of bilateral 
    anterior dislocation of the shoulder. .Journal of Clinical and 
    Diagnostic Research. 2010; 4(6):3567-3569. 
    85. Thomas DP, Graham GP. Missed bilateral anterior fracture 
    dislocations of the shoulder. Injury. 1996; 27(9):661-2. 
    doi:10.1016/s0020-1383(96)00121-0.
    86. Tripathy SK, Sen RK, Aggarwal S, Dhatt SS, Tahasildar N. 
    Simultaneous bilateral anterior shoulder dislocation: report of 
    two cases and review of the literature. Chin J Traumatol. 2011; 
    14(5):312-5. 
    87. Turhan E, Demirel M. Bilateral anterior glenohumeral dislocation 
    in a horse rider: a case report and a review of the literature. Arch 
    Orthop Trauma Surg. 2007; 128(1):79-82. doi:10.1007/s00402-007-0347-2.
    88. Upasani T, Bhatnagar A, Mehta S. BBilateral Neglected Anterior 
    Shoulder Dislocation with Greater Tuberosity Fractures. J Orthop 
    Case Rep. 2016; 6(2):53-56. doi:10.13107/jocr.2250-0685.432.
    89. Velkes S, Lokiec F, Ganel A. Traumatic bilateral anterior 
    dislocation of the shoulders. A case report in a geriatric patient. 
    Arch Orthop Trauma Surg. 1991; 110(4):210-1. 
    doi:10.1007/bf00571062.
    90. Wheelton A, Dowen D. A Case of Bilateral Anterior GlenoHumeral Dislocation following First Time Seizure. J Orthop Case 
    Rep. 2015; 5(2):38-40. doi:10.13107/jocr.2250-0685.269.
    91. Yuen M-C, Tung W-K. The use of the Spaso technique in a patient 
    with bilateral dislocations of shoulder. Am J Emerg Med. 2001; 
    19(1):64-66. doi:10.1053/ajem.2001.20014.
    92. Zoofaghari S, Wong A, Kiarasi P, Gheshlaghi F. Massive 
    Citalopram Overdose Associated with Recurrent Seizures and 
    Bilateral Shoulder Dislocations. J Res Pharm Pract. 2020; 
    9(3):161-164. doi:10.4103/jrpp.JRPP_20_24.
    93. Chahal J, Leiter J, McKee MD, Whelan DB. Generalized 
    ligamentous laxity as a predisposing factor for primary traumatic 
    anterior shoulder dislocation. J Shoulder Elbow Surg. 2010; 
    19(8):1238-42. doi:10.1016/j.jse.2010.02.005.
    94. Cucchi D, Baumgartner T, Walter SG, et al. Epidemiology and 
    specific features of shoulder injuries in patients affected by 
    epileptic seizures. Arch Orthop Trauma Surg. 2023 Apr; 
    143(4):1999-2009.doi:10.1007/s00402-022-04420-6.
    95. Sander JW, Hart YM, Johnson AL, Shorvon SD. National General 
    Practice Study of Epilepsy: newly diagnosed epileptic seizures in 
    a general population. Lancet. 1990; 336(8726):1267-71. 
    doi:10.1016/0140-6736(90)92959-l.
    96. Hofman K, Primack A, Keusch G, Hrynkow S. Addressing the 
    growing burden of trauma and injury in low- and middle-income 
    countries. Am J Public Health. 2005; 95(1):13-7. 
    doi:10.2105/AJPH.2004.039354.