Acute traumatic anterior glenohumeral dislocation complicated by axillary nerve damage: a case report

* Sports Sciences Resident, Canadian Memorial Chiropractic College, 1900 Bayview Avenue, Toronto, Ontario M4G 3E6. © JCCA 1998. Introduction The glenohumeral joint is the most frequently dislocated major joint in the body, and in some series, glenohumeral dislocations are more common than all other joint dislocations combined.1,2 Anterior dislocations of the shoulder account for between 80 and 95 percent of all shoulder girdle dislocations.3,4,5 The incidence of shoulder dislocations is generally higher in men than in women at a ratio of 2:1. In adolescence this difference may not be as great and may actually be reversed after the age of 60 years.1 The injury is common in ice hockey, wrestling, judo, rugby, football, basketball, baseball, and gymnastics. Initial traumatic anterior dislocations may be due to a force applied directly to the posterior aspect of the humeral head, driving it anteriorly. However, the more common mechanism in sport is an indirect force via the externally rotated and abducted limb, such as would be seen in a football player attempting to block a high pass or a hockey player sliding head first into the boards.6 There are several complications of anterior glenohumeral dislocations, of which recurrence is the most common. Others include fracture of the greater tuberosity of the humeral head (flap fracture), rotator cuff tear (partial and full-thickness tears), Bankart’s lesion (avulsion of the anterior capsule and glenoid labrum from the glenoid rim), Hill-Sachs lesion (compression fracture of the posterosuperior humeral head), and injury to the axillary, musculocutaneous, or median nerves. Vascular injuries are rare.7 The axillary nerve is the most frequently affected nerve of the brachial plexus.8 Literature suggests that 9–18% of patients who have anterior dislocation suffer prolonged pain due to injury of the axillary nerve.9 Subglenoid displacement of the humeral head into the quadrangular Un joueur de soccer d’élite présentait une luxation aiguë antérieure de l’articulation gléno-humérale classique accompagnée d’une atteinte nerveuse axillaire. L’article suivant examine l’incidence, le mécanisme de la blessure, le tableau clinique, le traitement conservateur ainsi que la réadaptation de la luxation antérieure de l’articulation gléno-humérale avec lésion nerveuse axillaire associée. (JACC 1998;42(3);150–155)