Summary about Disease
Luxatio Erecta Humeri, also known as inferior shoulder dislocation, is a rare and dramatic type of shoulder dislocation where the arm is fixed in an overhead position. The humeral head (the ball of the shoulder joint) dislocates inferiorly (downward) relative to the glenoid fossa (the socket of the shoulder joint). It accounts for less than 1% of all shoulder dislocations.
Symptoms
Severely abducted arm fixed in an elevated position. The arm cannot be lowered.
Elbow often flexed and the forearm positioned behind or above the head.
Significant pain.
Prominent bulge felt laterally (to the side) beneath the acromion (the bony prominence at the top of the shoulder).
Palpable humeral head along the chest wall.
Neurovascular compromise (e.g., numbness, tingling, loss of pulse in the arm or hand) may be present.
Causes
Luxatio Erecta is typically caused by high-energy trauma that forces the arm into extreme hyperabduction (raising the arm far above the head). Common causes include:
Falls from a height, with the arm outstretched.
Motor vehicle accidents.
Direct blow to an abducted arm.
Rarely, violent muscle contraction.
Medicine Used
Pain medication: Analgesics such as opioids (e.g., morphine, fentanyl) or NSAIDs (e.g., ibuprofen, naproxen) are used to manage pain before and after reduction.
Muscle relaxants: May be administered to help relax the muscles surrounding the shoulder joint, making reduction easier. Examples include benzodiazepines or other muscle relaxants.
Local Anesthetic: Sometimes injected into the joint space to reduce pain and muscle spasm to facilitate reduction.
Is Communicable
Luxatio Erecta is not a communicable disease. It is a traumatic injury.
Precautions
The following precautions are necessary after the reduction of Luxatio Erecta to prevent re-dislocation and promote healing:
Immobilization: The arm is typically placed in a sling or shoulder immobilizer for several weeks.
Pain management: Continue taking prescribed pain medication as directed.
Physical therapy: Initiated after a period of immobilization to restore range of motion, strength, and stability to the shoulder.
Activity modification: Avoid activities that could put stress on the shoulder joint until fully healed.
Follow-up appointments: Regular follow-up with the physician is necessary to monitor progress and address any complications.
How long does an outbreak last?
Luxatio Erecta is not an infectious disease and therefore does not have outbreaks. It is an injury. The recovery period following the injury varies but typically involves weeks to months of immobilization and rehabilitation.
How is it diagnosed?
Physical Examination: The characteristic presentation of the arm fixed in an overhead position is highly suggestive.
X-rays: Used to confirm the diagnosis and rule out fractures. The X-ray will show the humeral head dislocated inferiorly relative to the glenoid.
MRI (Magnetic Resonance Imaging): May be performed to evaluate for soft tissue injuries, such as rotator cuff tears or labral tears, after the dislocation has been reduced.
Neurovascular Assessment: Assess for nerve damage.
Timeline of Symptoms
Immediately after injury: Severe pain, inability to move the arm, arm fixed in an overhead position.
Following reduction: Pain will begin to subside with medication, but soreness and limited range of motion will persist.
Days to weeks: Gradual improvement in pain and range of motion with physical therapy.
Months: Continued improvement in strength, stability, and function of the shoulder. Full recovery may take several months.
Important Considerations
Neurovascular injury: It is important to assess and address potential neurovascular complications promptly.
Associated fractures: The presence of associated fractures can complicate treatment and prolong recovery.
Reduction technique: Gentle and controlled reduction techniques are essential to avoid further injury to the shoulder joint.
Post-reduction care: Proper immobilization and rehabilitation are crucial for optimal outcomes.
Recurrent instability: Patients may be at risk for recurrent shoulder instability following Luxatio Erecta, especially if there are associated soft tissue injuries. Surgical intervention may be required in some cases.