Simultaneous Reduction of Bilateral Anterior Shoulder Disloc
A 21-year-old male presented to the Emergency Department (ED) with acute, bilateral shoulder pain after awakening in bed. There was no preceding trauma, and there were no other symptoms or previous shoulder complaints. His medical history only stated insulin-dependent diabetes mellitus. A physical examination showed a muscular male, with both shoulders slightly abducted and internally rotated and a painfully, restricted range of motion. Bilaterally, a gap was palpated at the lateral deltoid muscle, and the humeral head was palpated anterior to the glenohumeral joint. There were no signs of sensory loss or vascular compromise. Plain radiography of both shoulders confirmed the clinically diagnosed bilateral anterior shoulder dislocation. Because of his type 1 diabetes, his nonfasting blood glucose level was measured, and it was 7.7 mmol/L.

The preferred self-reduction technique was discussed with the patient, and he was cooperative. Simultaneous, bilateral shoulder reduction was achieved using the BHM technique without anesthesia or analgesia, resulting in immediate relief of pain and restoration of shoulder function. Sensory function remained intact. Plain radiography confirmed bilateral glenohumeral reduction without fractures, Hill-Sachs, or bony Bankart lesions. The underlying cause of dislocation remained unclear. The patient was discharged from the ED with immobilization of both shoulders in an immobilizer for 2 weeks. Two weeks after the presentation in the ED, he was seen in the outpatient clinic. He was doing well and was instructed to start with movement exercises while taking care to avoid joined external rotation and abduction for 4 weeks. Six weeks after presentation, he remained asymptomatic with full restoration of shoulder function, and a routine referral to a physiotherapist was made to assist in the strengthening of his shoulder musculature.

Nonetheless, during these weeks, he awoke with muscle contractions following nocturnal hypoglycemic episodes on multiple occasions, for which he consulted his diabetes specialist. Repeated glucose measurements revealed that he was asymptomatic during his hypoglycemic episodes, and he was diagnosed with asymptomatic nocturnal hypoglycemia. After adjustment of his insulin regimen, the nocturnal convulsions subsided and he became symptomatic during a hypoglycemic episode. In hindsight, a nocturnal hypoglycemia-induced convulsion was the most likely cause of his bilateral anterior shoulder dislocation. For educational purposes, a follow-up call was made after 2 years. He had regained full bilateral shoulder function without recurrent dislocation or signs of instability and with adequate glycemic control; he no longer experienced nocturnal hypoglycemic episodes.