the clinical manifestation is typical and it is characterized by abduction of the affected arm , flexion of the elbow and pronation of the forearm .
bilateral luxatio erecta represents an extremely rare condition , and just a few cases were reported in medical literature . because of a high incidence of related complications such as neurovascular damages early recognition and treatment of this type of dislocation is required by physicians . in this article
we describe a case of a bilateral luxatio erecta that was successfully treated without long - term complications .
a 70-year - old female was accepted in our emergency department because of a bilateral shoulder pain that onsets after a sudden fall happened in her house .
the anamnestic research showed that the patient tumbled downstairs ; while clinging to both lateral banisters , she slipped down banging her face and chest to the ground . at physical examination
both shoulders were abducted and elevated approximately 90100 from the horizontal plane , with flexed elbows and with hands below the head .
the patient was unable to adduct and lower the arms , and there was immediate pain when attempting passive movements .
no vascular deficit was found , and the patient complained of slight paresthesias on both arms , with superficial and deep sensation deficit on both arms .
an x - ray examination was performed showing a bilateral inferior dislocation of humeral heads in relation with the glenoid fossa ; no fracture was associated ( fig .  1 ) .
1bilateral luxatio erecta bilateral luxatio erecta close reduction under sedation was achieved without difficulty by pushing the humeral head superiorly with an axial traction - countertraction maneuver on both shoulders .
x - ray control revealed a correct anatomic reduction of dislocations and after the reduction no vascular damage were found while paresthesias were still present on the left arm ( fig .  2 ) .
both arms were immobilized with bilateral slings in total adduction , intrarotation with the supinated arms .
2post - reduction x - ray the progressive mobilization of the shoulders started after 2  weeks with passive movements and pendulum codman s exercises .
after 3  weeks the patient gave up complaining paresthesias on the left arm and active movements were allowed .
after 8  weeks she recovered the complete function of both shoulders and after a one - year follow - up treatment the patient showed a complete range of motion of both arms .
inferior dislocations are rare ( 0.5% of all shoulder dislocations ) and bilateral inferior shoulder dislocations are exceptional : only 10 cases have been described so far in the literature . according to the literature , luxatio erecta is due to an indirect mechanism such as a violent abduction force on abducted limb resulting in impingement of the proximal shaft of the humerus against acromion .
direct axial loading from superior direction is another different mechanism , though less common . in our case
the first mechanism has to be taken into consideration ; in fact , while the patient was sliding in a sitting position downstairs , her hands were holding onto both banisters and the arms were abduced .
when she reached the ground floor the hands were blocked around the end of the banisters and her head and body were thrown forward by gravity .
the clinical presentation of an inferior shoulder dislocation is typical : the extremities are held over the head or abduced in a fixed position with the elbow flexed .
any passive movement is possible , and the humeral head is palpable on the chest wall .
x - ray shows the humeral head located below the rim of the glenoid and the humeral shaft is parallel to the scapular spine . in order to reduce inferior glenohumeral dislocation ,
it is recommended a traction counter - traction maneuver under sedation followed by immobilization in a desault bandage for at least 2  weeks .
there is a high incidence of associate tears of the rotator cuff ( 12% of patients )   and a slap lesion has been described by schai and hintermann   after a post - reduction arthroscopic assessment view .
fracture of the acromion , clavicle , inferior glenoid fossa and greater tuberosity represent a complication that should need a surgical treatment .
neurovascular damages are also commonly associated with inferior shoulder dislocation [ 5 , 7 ] ; garcia et al .   described a case of bilateral luxatio erecta complicated by an axillary vein thrombosis . in general , neurologic injuries ( 60% of cases ) of brachial plexus , axillar , radial and ulnar nerves
are more common than vascular injuries but they tend to resolve after reduction with an excellent prognosis , suggesting the neuropraxia as the main mechanism of the injury [ 5 , 9 , 10 ] .
 luxatio erecta is an uncommon form of glenohumeral dislocation 
 . cases of bilateral inferior shoulder dislocation ( luxatio erecta ) are very rare , and only ten cases have been described in literature . 
 we describe a case of a woman with bilateral luxatio erecta of the shoulders treated with close reduction , immobilization and rehabilitation . 
 the patient had fallen downstairs while clinging to both lateral banisters . 
Introduction
Case report
Discussion