Tramadol intoxication and shoulder pain.

An unconscious 21-year-old male was brought to our emergency room (ER) three hours after ingesting 2 g of tramadol and 400 mg of methadone. He had one episode of generalized tonic-clonic seizure before arriving to the ER. After regaining of consciousness, the patient complained from pain in his right shoulder. Anterior dislocation of the patient’s shoulder was confirmed on plain x-ray (Figure 1). One of the complications of tramadol use, abuse, or overdose is generalized tonicclonic seizure1. Anterior dislocation of the shoulder following epileptic seizures is more usual than the posterior type2-4. Also, it has been stated that despite the posterior dislocation, anterior dislocation of the shoulder needs regular follow-up to detect any recurrent shoulder instability for which the treatment will involve skeletal reconstruction2. This case highlights that the suspicion of shoulder dislocation should arise in every tramadol-intoxicated patient who complains of pain or stiffness of the shoulder after a seizure.