A Case Report on Arthroscopically Managed Irreducible Anterior Shoulder Dislocation with Entrapped Anterior Capsule.

Abstract

Introduction: The shoulder is the most mobile joint and also the most commonly dislocated joint in our body. Anterior dislocation of the shoulder is more common than posterior and inferior dislocation. Anterior dislocation of the shoulder can be easily reduced by the Stimson technique, traction-counter traction technique, etc. Reducing an acute anteriorly dislocated shoulder is usually easy, but in some instances, it can be difficult due to the interposition of the long head of the biceps, subscapularis, or impacted Hill-Sach. This is a case report of a patient with 10 days old irreducible anterior dislocation of the shoulder. Magnetic resonance imaging (MRI) shows the anterior capsule trapped between the humeral head and glenoid, which does not allow the shoulder to be relocated. This case report highlights the possibility of anterior capsule entrapment in the glenohumeral joint with the subscapularis being intact and that it can be managed by arthroscopy, which has fewer complications than open surgery.

Case report: A 55-year-old male came with irreducible anterior dislocation of his left shoulder after a slip and fall on his outstretched hand. There was a history of attempts to reduce the dislocation in another hospital but failed to reduce it even under sedation. An MRI of the left shoulder shows that the anterior capsule got entangled between the humeral head and glenoid, as shown in Fig. 1 and 2, and is not allowing the humerus head to reduce. There are reports of the irreducible anterior dislocated shoulder due to interposition of the subscapularis muscle, long head of biceps, greater tuberosity fracture fragment, etc., and are managed by open surgery. In our case report, we managed to disengage the entrapped anterior capsule by arthroscopy after a trial of closed reduction under general anesthesia.

Conclusion: Irreducible shoulder dislocation is not a common problem. There are many pathologies that result in the irreducibility of shoulder dislocation; anterior capsule entrapment is one such pathology. Open surgery is not the only solution to address these pathologies; we can treat them by arthroscopy technique, which can address all associated pathologies with minimal complications, unlike open surgery.