Rare Case of Chronic Unreduced Shoulder Dislocation: A Case Report and Literature Review

Chronic unreduced shoulder dislocations (CUSDs) are rare with a prevalence of 0.10-0.18%, usually occurring after car crashes, falls, assaults, getting out of bed, and seizures. Management is often open reduction and fixation. Most cases have been reported in countries with inadequate resources and access to care often leading to misdiagnosis and poor management. We report a case of a patient with a CUSD presenting to a chiropractor within a federally qualified health center (FQHC).

A 55-year-old, Spanish-speaking, uninsured, female was referred from her primary care provider to a chiropractor within a FQHC with right shoulder pain and reduced range of motion. The patient reported two incidences of right shoulder dislocation, the first being a closed reduction 1 year before presentation and the second occurring 5 months before presentation without any management. Radiographs demonstrated an unreduced right anterior shoulder dislocation. The patient was referred to an orthopedist who treats patients on a sliding scale according to their income.

Because the patient was uninsured and did not have the necessary financial resources, she was unable to receive a shoulder reduction. These barriers often contribute to the misdiagnosis and increase morbidity associated with this pathology. Exercise therapy was not advised out of concern for further structural damage and neurovascular compromise. The recommended management is with topical pain creams and corticosteroid injections as directed by their primary care. Clinicians working with this population should be aware of the diagnosis, both typical and urgent features, complications, and the standard of care in this condition.