shoulder dislocations are difficult to manage and require extensive procedures to obtain good functional outcome . very few cases are described in literature showing neglected shoulder dislocation with good functional range of movement . we report a case with 3 years of neglected anterior shoulder dislocation with preserved joint function . a 40 years old gentleman presented withfracture distal end of the radius ( left ) . on clinical examination we observed that he had anterior dislocation of his left shoulder which was confirmed on radiographic evaluation . he had history of seizures 3 years back , which may be the cause of dislocation which went unnoticed . on examination he had good range of motion without any pain . patient could perform all routine activities with no major functional limitation . at three years after dislocation ct scan showed neocavity formation . neglected shoulder dislocation with preserved joint function without major functional limitation is a rare presentation . observation can be a treatment option in patients with preserved range of movement especially involving non dominant handand having low functional demand . this report presents rare presentation of neglected shoulder dislocation highlighting its natural history and its outcome following conservative treatment . anterior shoulder dislocation constitutes 95% of all shoulder dislocations , mainly caused by trauma and posterior dislocation is caused by indirect trauma like violent muscular contractions seen in epileptic attack and electrocution . unilateral shoulder dislocation is most common constituting 85% of all dislocations [ 1 , 2 ] . because of its typical presentation neglected shoulder dislocation presents with gross limitation of shoulder function and requires extensive procedures to obtain desired outcome . also , there are many pathological changes in bony and soft tissue architecture in shoulder joint in case of neglected dislocations . we present a rare case of anterior dislocation of shoulder following a seizure attack with preserved joint functions and no major functional limitation of joint function . in this report we bring this rare presentation of neglected shoulder dislocation highlighting its natural history and its outcome following conservative treatment . a 31 years old right hand dominant gentleman presented to our orthopedic specialty clinic with fracture distal end radius on left side . on further evaluation , there was deformity in ipsilateral shoulder joint and asymmetry was present as compared to opposite side . range of motion were flexion upto 170 degrees ( fig 1a ) , extension up to 10 degree ( fig 1b ) , internal rotation up to l3 ( fig 1c ) , and external rotation up to 30 degree ( fig 1d ) and abduction up to 120 ( fig 1e ) in both active and passive movements , further movements were restricted and mildly painful . however he gave a history of seizure attacks three years back following which he had shoulder pathology . radiographs of shoulder joint were taken which confirmed anteriorly dislocated humeral head ( figure 2 ) . mri scan showed anteroinferior shoulder dislocation with intact rotator cuff muscles ( fig.4a,4b ) since the patient had good functional range of movement we explained him the treatment options . ( a , b , c , d & e ) : clinical photographs showing functional range of movement of shoulder joint radiograph of joint showng anteroinferior dislocation of shoulder joint ( a , b , c & e ) : ct scan showing anteroinferior dislocation with neocavity formation . ( a & b ) : mri scan showing anteroinferior dislocation with intact rotator cuff muscles anterior dislocation of shoulder unlike posterior dislocation is most commonly traumatic in nature . the mechanism of anterior dislocation following trauma is that greater tuberosity abuts against acromion when arm is abducted and extended , causing leverage forces leading head to come out of glenoidcavity . posterior dislocation secondary to seizure attack is caused due to imbalance between strong internal rotators and weak external rotators and deltoid . the cause of anterior dislocation following seizure is postulated to be direct trauma due to collapse of patient hitting the floor . anterior dislocation of shoulder is commonly missed after seizure because of its unusual occurrence , post seizure drowsiness and subsequent medical management . the term chronic dislocation of shoulder is applied to condition where there is loss of recognition of injury for at least 3 weeks   or 4weeks . rowe and zarin presented eight patients with anterior dislocation with seven patients presenting at 3 week to 2 year interval and one patient at 10 year duration . goga presented 31 patients with chronic anterior dislocation with longest duration of failed recognition at 2 years . postacchini and facchini presented five patients with 6 weeks as longest duration of failure of diagnosis . mansat et al showed five patients with 6 weeks to 3 years as the duration of missed diagnosis . treatment options for neglected shoulder dislocation include observation , manipulation , open reduction with or without allograft reconstruction , bankarts repair , capsulolabial repair and arthroplasty [ 7 , 13 ] . surgical treatment for chronic dislocations is usually advocated for better functional outcome , however the results can be poor and unsatisfactory . very few cases describe chronic dislocation of shoulder with good functional range of motion which were treated nonsurgically . essi et al showed a case with 15 years old neglected anterior shoulder dislocation in a 35 year old lady with good functional range of movement and neocavity formation leading to preserved movements . similar neocavity formation seen in a case described by mancinni et al with 24 years of neglected dislocation ion a 74 year old lady with low functional demand . jerosch et al   presented a case of a young male with preserved movements 4 years after missed diagnosis . this case did nt show neocavity formation , but had a large hill sachs lesion which locked the head in dislocated position . in our case thus , we conclude that neglected shoulder dislocation after many years eventually leads to neocavity formation . observation can be an option if patient presents late and surgical treatment is likely to have unsatisfactory results . low demand patient with involvement of non dominant hand can be observed with good functional outcome . neglected shoulder dislocation can present with neocavity formation and preserved joint function . in such cases , observation can be a treatment option especially when surgical option gives unsatisfactory result .
introduction : shoulder joint is the most frequently dislocated joint . however , it is rarely neglected and treatment is sought immediately . delayed or neglected 
 shoulder dislocations are difficult to manage and require extensive procedures to obtain good functional outcome . 
 very few cases are described in literature showing neglected shoulder dislocation with good functional range of movement . 
 we report a case with 3 years of neglected anterior shoulder dislocation with preserved joint function.case report : a 40 years old gentleman presented withfracture distal end of the radius ( left ) . on clinical examination 
 we observed that he had anterior dislocation of his left shoulder which was confirmed on radiographic evaluation . 
 he had history of seizures 3 years back , which may be the cause of dislocation which went unnoticed . on examination he had good range of motion without any pain . 
 patient could perform all routine activities with no major functional limitation . at three years after dislocation ct scan showed neocavity formation.conclusion:neglected shoulder dislocation with preserved joint function without major functional limitation is a rare presentation . 
 this condition should be kept in mind in patients with history of seizures . 
 proper evaluation and counseling of patients avoids extensive procedures and avoids complications of surgery . 
 observation can be a treatment option in patients with preserved range of movement especially involving non dominant handand having low functional demand . 
 this report presents rare presentation of neglected shoulder dislocation highlighting its natural history and its outcome following conservative treatment .