Voluntary Shoulder Dislocation in Children. Case Report

Abstract

Background: Voluntary dislocation of the glenohumeral joint represents the ability to spontaneously dislocate a shoulder in one or more directions. The theoretical cause is the ability to contract agonist muscle groups, and inhibiting or relaxing antagonistic muscles, thus determining the direction of the dislocation. The diagnosis is usually made in childhood or adolescence when the patient demonstrates a voluntary shoulder dislocation. Historically, this condition has been linked to psychological disorders or illness and typically responds poorly to surgical interventions. Treatment typically consists of conservative management including cognitive behavioral therapy or physical therapy. Prior prospective studies have demonstrated no advantage to surgical interventions over nonoperative treatments, and in some cases with associated increased morbidity.
Case Report: Being a rare condition, two cases of voluntary shoulder dislocation are reported. The first patient is a boy, 12-year-old with 2 years of voluntary bilateral posterior shoulder dislocations, with 17-year follow-up, the patient did well. The second case is an 8-year-old girl with voluntary posterior dislocation of the right shoulder who after three year follow up responded well to conservative treatment.
Discussion: The risk of developing osteoarthritic changes or the appearance of chondral lesions are major long-term concerns with this disease. Currently there is no specific treatment consensus and little evidence regarding the prognosis of this condition. Voluntary shoulder dislocation is a rare entity of unknown etiology. Patients report no history of trauma but is often associated with psychiatric conditions. Prospective studies have reported favorable results of nonoperative treatment during childhood. Evidence Level: IV