Case reports generally follow the format below:

Disclosure: none
Setting: Tertiary care medical center.
Patient: A 41 year-old man with bilateral posterior shoulder dislocation.

Case Description: The patient presented status post massive electrical shock injury while working as an electrician. The patient was on a two-step ladder when the event occurred, and the shock forced him backwards, with loss of consciousness and an initial Glasgow Coma Scale of 14. A non-contrast head CT revealed an acute temporal lobe contusion with foci of internal hemorrhage. This finding was stable on subsequent CTs and no surgical intervention was undertaken. Included in the initial workup was a chest CT, which showed bilateral posterior shoulder dislocations, which was confirmed with further diagnostic testing.

Assessment/Results: The patient was evaluated by orthopedics and his shoulder dislocations were closed reduced. He was made non-weight bearing on his bilateral upper extremities and transferred to the inpatient rehabilitation unit. Delayed reconstructive surgery was planned. During the patient’s hospital course, his case was further complicated by unilateral shoulder pain and swelling. After an extensive workup, the patient was eventually diagnosed with thrombophlebitis and transferred to medicine well before rehabilitation was completed.

Discussion: Posterior shoulder dislocations account for only one to four percent of all dislocations, and only five percent of these occur bilaterally. Mostly secondary to epileptic seizures, this injury is frequently missed. In fact, over sixty percent of this sort of dislocation is initially overlooked.

Conclusion: The diagnosis of posterior shoulder dislocations presents a unique diagnostic and rehabilitative challenge. Physiatrists should be aware of this injury given the rapidity with which many patients are transferred to inpatient units. Additionally, the connection of thrombophlebitis following posterior dislocation should be explored.

Key Words: Shoulder; Dislocation; Posterior; Rehabilitation; Electrocution

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