Bilateral anterior dislocation of the shoulder: review of seventy cases and proposal of a new etiological-mechanical classification.

BACKGROUND: Although anterior shoulder dislocation is common in everyday practice in Emergency Departments, bilateral presentation is a rare entity. OBJECTIVES: The aim of this article is to report two additional cases of this rare injury and to introduce a new mechanism that can produce it. We made an exhaustive review of the literature and found 68 cases in printed publications. Also, we analyzed the mechanism of injury and the presence of predisposing factors, and propose a new etiological-mechanical classification. CASE REPORT: One case occurred after a trivial fall, and the other was produced by a mechanism not previously reported: the patient pushed strongly forward, expecting a resistance and finding none, his arms kept the forward movement and the shoulders dislocated. DISCUSSION: This lesion has a bimodal distribution, affecting mainly men (70%) with a mean age of 33.5 years, whereas in women, the average age is 57 years. The most common cause is trauma (50%), followed by muscle contractions (37%) due to seizures of different causes (epileptic, hypoglycemia, toxic, or hypoxic) or electrocution. In 15.7% of the cases, the diagnosis of bilateral anterior dislocation was not acute (<3 weeks), and in virtually all of these cases it was not traumatic. CONCLUSION: The bilateral anterior shoulder dislocation may not be as rare as previously thought and must be taken into account in emergency services. The authors propose a new etiological-mechanical classification. Also, the importance of radiologic diagnosis must be highlighted.

Histomorphometry of the ligaments using a generic-purpose image processing software, a new strategy for semi-automatized measurements.

Gold chloride technique can be combined with Adobe Photoshop® software to yield a quantitative assessment of the different areas in heterogeneous structures as are ligament. A semi-automatized method based on the sum of two- and three-dimensional morphological criteria upon colorimetric criteria allows the identification and measurement of the area occupied by a structure of interest. It also allows the quantification of color intensity to differentiate structures with similar staining avidity, like vessels and nerves. This computer-assisted, semiquantitative procedure for computerized morphometry is relatively simple to perform. The accuracy, efficiency, and reproducibility of this method based on a commercially available imaging program were considered adequate when tested on the anterior cruciate ligament of the cat. Image normalization by trained observers using a commercially available software package designed for photography, applied to a sample randomly chosen, has provided the means of making reproducible measurements of heterogeneous structures.