bilateral anterior shoulder dislocation: a systematic review

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 convulsantevent. 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.