Neurovascular Injury Following Traumatic Posterior Shoulder Dislocation in an Adolescent Contact Athlete: A Case Report.

T he glenohumeral joint is the most mobile and one of the most frequently dislocated joints in the human body. Before skeletal maturity, shoulder dislocations are less frequent, and shoulder trauma more often results in fracture through the proximal humeral physis. In a recent epidemiologic study, Zacchilli and Owens found that shoulder dislocations follow a bimodal distribution, with 46.8% occurring in patients between fifteen and twenty-nine years of age; shoulder dislocations were less common in children under fifteen years of age. The majority of traumatic shoulder dislocations in all age groups are anterior dislocations. Approximately 10% of shoulder dislocations in children are posterior; this percentage is slightly higher than that reported in the adult population because of increased ligamentous laxity in children. Neurovascular complications following simple shoulder dislocations are rare. In a multicenter, five-year retrospective analysis of isolated shoulder and elbow dislocations, Sparks et al. found only nine axillary artery injuries (0.97%) in association with 931 shoulder dislocations. The reported incidence of isolated axillary nerve injury is between 0.3% and 6% of all brachial plexus injuries; however, the true incidence following a shoulder dislocation is difficult to determine as subclinical injury to the axillary nerve may be present following dislocation. Combined neurovascular injuries following shoulder dislocation are even more atypical and most often result from violent high-energy traction or blunt forces to the shoulder girdle as seen in scapulothoracic dissociation. The occurrence of neurovascular injuries following shoulder dislocation in the pediatric population is uncommon. We are aware of only one case of isolated vascular injury and one case of isolated axillary nerve injury in pediatric patients following a simple shoulder dislocation. To our knowledge, ours is the first case report of a combined neurovascular injury of the upper limb following a shoulder dislocation in the pediatric population, and also the first report of such an injury occurring following a posterior shoulder dislocation. Our goal is to increase awareness for those treating pediatric trauma patients, which may lead to earlier detection and management of this injury. The parents of the patient were informed that data concerning the case would be submitted for publication, and they consented verbally.