PMC7607956_01
Initial X-rays of left shoulder, elbow and hand. (a) Inferior shoulder dislocation and clavicle fracture. (b) Posterior dislocation of elbow. (c) Scaphoid and Bennett fractures.
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F1
Radiological evaluation revealed the diagnosis of inferior shoulder dislocation and posterior elbow dislocation (Figure 1).
Reduction maneuver with schematic figures.
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F2
He placed his right hand's palm on the patient's chest to provide counter traction so that volar side of surgeon's wrist was lightly touching and leveraging the dislocated humeral head (Figure 2a). Then, he twisted his torso in counterclockwise direction to generate upward and outward traction (Figure 2b) and gradually adducted the patient's arm by taking small side steps, changing his position but maintaining the traction generated by his dynamic trunk posture (Figure 2c, d).
Three-dimensional computed tomography reconstruction showing concentric reductions of shoulder. Minimally displaced fractures of clavicle and humerus greater tubercle can also be seen.
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F3
Both joints were reduced but there was a minimally displaced humerus greater tubercle fracture (Figure 3).
Coronal T1-weighted magnetic resonance image of shoulder demonstrating complete rupture of supraspinatus tendon. Loss of deltoid muscle mass is obvious.
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F4
At third month, the range of motion at left shoulder was not satisfactory and magnetic resonance imaging was performed which revealed complete rupture of the supraspinatus tendon (Figure 4).
Patient was able to elevate his arm more than 160 degrees but apparently with external rotation of shoulder.
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F5
However, the patient was elevating the left arm approximately 160 degrees without any pain apparently with compensatory action of accessory muscles and external rotation of shoulder as well as by increased rotation of the scapula (Figure 5).