Ultrasound-guided interscalene block for the reduction of luxatio erecta in a high-risk patient: A case report

Abstract

Background

Inferior glenohumeral dislocation (IGD), or luxatio erecta humeri, is a rare shoulder dislocation, accounting for 0.5 % of all cases. It often results from hyperabduction of the arm, causing the humeral head to dislocate inferiorly. IGD is associated with neurovascular complications, particularly in elderly patients with comorbidities. Traditional management involves procedural sedation, which may be risky in high-risk patients. Ultrasound-guided interscalene nerve blocks offer a safer alternative by providing localized pain control without sedation.

Case report

We report the case of an 85-year-old male with multiple comorbidities who presented with IGD after a fall. Given the patient's risks, an ultrasound-guided interscalene block was used for reduction. Reduction was achieved using the traction-countertraction method, confirmed by post-reduction radiographs. The patient experienced no immediate complications, and at follow-up, showed no signs of re-dislocation or neurological deficits.Why should an emergency physician be aware of this? Ultrasound-guided interscalene nerve blocks provide a safe and effective alternative to procedural sedation for IGD reduction, especially in high-risk patients. This approach minimizes opioid use, improves outcomes, and reduces emergency department resource utilization. Future guidelines should consider incorporating this technique for similar cases, with further studies needed to evaluate long-term outcomes.