such dislocations are usually caused by sports injuries , epileptic seizures , electrical shock , or electroconvulsive therapy . however , simultaneous bilateral anterior shoulder dislocation is very rare and usually is of traumatic in origin with only few cases described in literature .
thorough clinical examination of the patient is mandatory in order to ensure that a bilateral dislocation is not missed .
the following case report demonstrates a typical bilateral shoulder dislocation as a result of trauma in a 24-year - old male .
a 24-year - old man presented to accident and emergency department with complaints of acute shoulder pain involving both shoulders after trying to prevent a fall . he tried to prevent falling backward by extending both arms behind his back .
physical examination showed fullness over anterior aspect and bilateral squaring of his shoulders ( epaulet sign ) .
both humeral heads were palpated in the anterior aspect of each joint and there was a global , painful restriction of range of motion in both shoulders , without any evidence of peripheral motor , sensory and vascular deficit .
radiographs confirmed bilateral anterior glenohumeral dislocation with greater tuberosity fracture on left side [ figure 1 ] .
reduction of both shoulders was obtained which was confirmed radiologically [ figure 2a and b ] . since the greater tuberosity fracture of left shoulder returned to its anatomical position after reduction , so it was decided to manage the fracture conservatively .
radiographs demonstrating the bilateral anterior shoulders dislocation with fracture greater tuberosity left side ( a and b ) post - reduction x - ray showing congruent reduction of bilateral shoulder joint and anatomically reduced greater tuberosity fracture left side the patient received physical therapy as tolerated and no further episodes of instability ensued . at follow - up of two months
the patient reported no pain and had returned to his normal activities of daily living with minimal discomfort .
both shoulders had near normal range of motion with pain only present at the extremes of motion .
radiographs showed an anatomical consolidation of greater tuberosity fracture of left shoulder joint . at the end of one year
follow up , the fracture has united with no restriction of motion and the shoulders were defined as stable .
bilateral shoulder dislocation was first described in 1902 in patient in whom excessive muscular contractions occurred as a result of camphor overdose .
dunlop et al . , reported in 2002 of other cases in the literature , but most were associated with fractures .
bilateral posterior shoulder dislocations occur mostly due to electrical shock , seizures or hypoglycaemic episodes , and these occur as a sequel of maximal involuntary muscle contractions .
the weaker external rotating muscles are overpowered by the stronger internal rotators , resulting in adduction and internal rotation sufficient dislocate the humeral head posteriorly . unlike posterior dislocations , anterior dislocations occur more commonly following trauma .
our patient had minor trauma after falling backwards with his arms extended behind his back .
the dislocation mechanism in our case is a protective effort in an unbalanced position both created a typical shoulder dislocation mechanism .
this is the first case reported of a patient dislocating both shoulder by this mechanism .
cresswell and smith reported a case of bilateral anterior dislocation of the shoulder without any fractures in a bench - pressing athlete .
singh and kumar reported a case of sequential bilateral anterior dislocation in which the left shoulder dislocated first due to trauma followed by atraumatic dislocation of the right shoulder . galois et al .
early reduction and immobilisation should be followed by definite treatment , which may include active and passive physiotherapy or surgery in the younger , more active patient group .
this poses obvious problems in the case of bilateral injuries when the patient may require remain in hospital for an extended period .
a fracture of the greater tuberosity occurs in approximately 10% of dislocations and is usually associated with the humeral head in a subglenoid , low subcoracoid , or subclavicular position . in these cases ,
the greater tuberosity is displaced in the approximately 15% of all anterior shoulders dislocations of the shoulder .
the diagnosis of a rotator cuff tear is almost sure when the fracture of the greater tuberosity is displaced .
possible rotator cuff tears and other shoulder pathologies should be investigated by magnetic resonance imaging ( mri ) .
mri was not used in our cases because of financial constraints and plan of conservative treatment .
functional impairment is commonly seen if the greater tuberosity is not reduced anatomically . in our patient
it is important to take accurate clinical history , a thorough clinical examination and adequate imaging in order to exclude this injury .
this is especially of concern , since the reported rate of late diagnosis is greater than 10% .
predisposition to bilateral dislocations may be higher in older age group because of balance problems .
 shoulder dislocations are the most common major joint dislocations encountered in the emergency departments . 
 bilateral shoulder dislocations are rare and of these , bilateral posterior shoulder dislocations are more prevalent than bilateral anterior shoulder dislocations . 
 bilateral anterior shoulder dislocation is very rare . 
 we present a case of 24-year - old male who sustained bilateral anterior shoulder dislocation following minor trauma , with associated greater tuberosity fracture on one side . 
 prompt closed reduction followed by immobilization in arm sling and subsequent rehabilitation ensured a good outcome . 
INTRODUCTION
CASE REPORT
DISCUSSION
CONCLUSION