Voluntary

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ETHAN

Voluntary

dislocation

radiographic

findings

of the shoulder

similar

Glenohumeral
M. BRAUNSTEIN1

is a rare condition

to traumatic

AND

with

dislocation.

Glenohumeral
dislocations
are usually
traumatic,
but occasionahhy
they are voluntary.
Such voluntary
dislocations tend to occur in adolescents
who seem to have the
ability
to spontaneously
dislocate
the humeral
head and
then reduce
it painlessly.
Inasmuch
as the radiographic
findings
in posttraumatic
dislocations
are similar
to
those in voluntary
ones, it is important
for the radiologist
to be aware of this condition.
This report describes
three
patients
in whom
this was observed.

Case

Reports

A 15-year-old male was noted to have the ability to posteriorly

sublux both shoulders.
This was accompanied
by a clicking
noise. There was no prior history of involuntary
subluxation
or
shoulder
trauma. The patient was placed on an exorcise program to strengthen
the abductors
and internal and external
rotators of the shoulders.
He continued
to do well 2 years later;
however, he did retain the ability to voluntarily
posteriorly
dislocate his shoulders
(fig. 1).
Case 2

A 17-year-old
female noted giving way of the left knee for
about 2 years after a gymnastics
accident, and popping
of the
right shoulder for about 7 years since a questionable
hyperabduction injury. On physical examination,
she was able to voluntanily sublux her shoulder
on abduction
and extension
of hen
arm. Examination
of the knee revealed no patollar subluxation.
An exercise program was suggested,
and the patient was doing
well after 4 months.
Case

A 24-year-old
male medical student sustained
an abduction
injury
to his right arm 5 years before examination.
For about 1
year, he noticed the ability to voluntarily
dislocate
his right
shoulder anteriorly
(fig. 2). Surgical treatment
is planned.

1 . Rowe

CA, Pierce DS, Clarke JG: Voluntary

dislocation
of
the shoulder. J Bone Joint Surg (Am] 55 :445-460,
1973
2. Keisen AP, Wilson CL: Bilateral recurrent dislocation
of the
shoulder (atraumatic)
in a thirteen-year-old
girl: report of an
unusual case. J Bone Joint Surg fAmJ 43 : 553-554, 1961
3. Howorth
MB: General relaxation
of the ligaments.
C/in Orthop 30:133-143, 1963

Our experience
with voluntary
shoulder
dislocation
is
in agreement
with previous
descriptions
[1]. Certain
featunes differ significantly
from those in traumatic
dishocathe

preponderance

copt

for

dislocations

of

the

Am J Roentgenol

129:911-912,

latter

associated

Received
May 9. 1977; accepted
after
I
Department
of Radiology,
University

MARTEL

REFERENCES

Discussion

tions;

WILLIAM

whereas
the spontaneous
variety is more commonly
postenon. The voluntary
dislocations
are usually
elicited
in
abduction
and extension,
and in cases
1 and 2, the
posterior
subluxation
was best demonstrated
on axillary
views in abduction.
It should
be noted that transthoracic
views may not show a subluxation
in these cases,
inasmuch
as they are generally
obtained
in the adducted
position.
In addition
to the frontal
projection,
we believe
the axillany
view is most helpful
in demonstrating
glenohumenal
subluxations
in general.
None of our patients
was treated
surgically.
However,
in one reported
case of bilateral
voluntary
dislocation,
the labrum
was found to be detached
from the glenoid
on
one side only [2]. This finding
has not been observed
in
other
cases.
The only other
surgical
finding
to which
reference
has been
made
is redundancy
of the joint
capsule,
said to be present
in about half the cases [1].
The pathogenesis
of this condition
is not entirely
clear.
In some instances,
as in cases 2 and 3, there is appanenthy a history
of shoulder
trauma
after which the patient
becomes
aware of ability
to spontaneously
dislocate
the
joint. The significance
of such trauma
is not clear.
It is
possible
that the potential
for shoulder
dislocation
antecedes
the trauma,
and that there is no causal
relationship. It has been proposed
that generalized
higamentous
laxity may be responsible
for this condition
[3]. An association
with poor posture,
genu valus, and weak arches
has been noted.
However,
many patients,
perhaps
the
majority
with this condition,
do not show evidence
of
generalized
joint laxity.
There
has been no evidence
of
diffuse
connective
tissue disease,
such as Ehlers-Danlos
syndrome,
in any of the reported
cases.
The radiologist
should
be aware
of this condition
in
evaluating
patients
with a history
of trauma,
so as not to
erroneously
conclude
that such
subluxations
must
of
necessity
be traumatic.
Furthermore,
it is possible
for
patients
to reduce
their dislocations
during
the course
of
a nadiologic
examination,
so that in some views there
appears
to be a glenohumeral
subluxation
whereas
in
others
this is not the case. This was our experience
in
two cases.

Al-

though
these dislocations
may be anterior,
the majority
are
posterior.
Three
cases
of spontaneous
dislocation
are described.
While two of these cases had previous
trauma to the
joint, it is possible
that there is no causal relationship.
Voluntary dislocations
are usually
elicited
in abduction
and extension; frontal and axillary views are most helpful in demonstrating glenohumeral
subluxations.

Case

Dislocation

are

with

anterior

(ox-

convulsions),

revision
July 11, 1977.
of Michigan
Medical
Center,

November

1977

Ann

Arbor,

911

Michigan

48109.

Address

reprint

requests

to E. M. Braunstein.

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912

BRAUNSTEIN

AND

MARTEL

Fig. 1.-Case
1. Anteroposterior
(A) and axillary (B) views showing
voluntary
posterior
subluxation
of
right
shoulder.
Anteroposterior
(C)
and axillary (0 ) views after voluntary
relocation.

Fig. 2.-Case
3. A, Anteropostenor view showing
voluntary
anterior
dislocation
of right shoulder.
B, Re-

peat film a few seconds

ing voluntary

.,.

relocation.

later show-