CHRONIC POSTERIOR SHOULDER DISLOCATION: A CASE SERIES

Case 1

A 25 years old male patient presented to a private clinic in Fallujah city on 11/10/2024 with left shoulder pain and limitation of movement for 2 months. The forearm was clasped to his chest with inability to perform external rotation of the forearm. The patient had a history of electrical shock injury prior to his compliant.

On examination, there was loss of shoulder contour with limitation of movement with a positive posterior drawer test. Radiographs showed a light-bulb appearance ( Figure 1). The CT scan showed Reverse Hillsach lesion ( Figure 2).

Figure 1. AP view of shoulder with Light Bulb appearance.

Figure 2. CT of shoulder with Reverse Hillsach lesion.

The management plan involved surgical reduction of this dislocation using the Modified McLaughlin Procedure. The patient was admitted to the operative room in Fallujah Teaching Hospital to undergo the surgical procedure using the deltopectoral approach to reduce the dislocation by the open method with transfer of the subscapularis with its lesser tuberosity to the defect (Reverse Hillsach) on the anterior part of the Humeral Head ( Figure 3).

Figure 3. Intraoperative open reduction with fixation of the lesser tubercle with subscapularis muscle to the reverse Hillsach Lesion.

Postoperatively, the patient wore a Gunslinger sling for 4 weeks, followed by exercise. The postoperative radiograph is shown in ( Figure 4).

Figure 4. Post-operative radiograph with screw fixation of the lesser tuberosity to Reverse Hillsach defect.

Patient perspective

The patient expressed significant satisfaction with the outcome, noting that he could finally return to his daily activities without the constant pain and severe limitation he had experienced for two months following the injury.

Case 2

A 52 years old female patient presented to a private clinic in Fallujah city on 8/3/2025, with left shoulder pain and limitation of movement for 3 months. Her symptoms occurred after an episode of convulsions.

On examination, there was loss of external rotation movement of the shoulder. The X-rays showed a light-bulb appearance ( Figure 5). The CT scan: shows Reverse Hillsach lesion ( Figure 6).

Figure 5. AP view of shoulder with Light Bulb appearance.

Figure 6. CT-scan of shoulder with Reverse Hillsach lesion.

The management plan involved surgical reduction of this dislocation using the Modified McLaughlin procedure. The patient was admitted to the operative room at Fallujah Teaching Hospital to undergo the surgical procedure using the deltopectoral approach to reduce the dislocation by the open method with transfer of the subscapularis with its lesser tuberosity to the defect (Reverse Hillsach) on the anterior part of the Humeral Head with Bone Graft ( Figure 7).

Figure 7. Intraoperative open reduction with fixation of the lesser Tuberosity with the subscapularis and bone grafting to the reverse Hillsach Lesion.

Postoperatively, the patient wore a Gunslinger sling for one month followed by exercise. The postoperative radiograph is shown in ( Figure 8).

Figure 8. Post-operative radiology with secured fixation using one screw of the lesser tuberosity to the Reverse Hillsach lesion.

Patient perspective

The patient reported a high level of satisfaction after the surgery, specifically highlighting the restoration of her shoulder’s external rotation, which allowed her to regain independence in her personal care.

Case 3

An 18 years old male patient presented to a private clinic in Fallujah city on 12/7/2025, with right shoulder pain and limitation of movement for 2 months. He had a history of falling, was admitted to the emergency department, and was told that he had a shoulder dislocation (there was no radiological document for his first dislocation). The patient underwent closed reduction (as he said), and later on, the patient still complained of limitation of movement of the right shoulder with severe pain and was admitted to a private clinic seeking relief.

The patient was sent for X-rays that showed a light-bulb appearance ( Figure 9). The CT scan showed the impaction of the Humeral Head in the glenoid fossa with an internally rotated Humeral Head that locks the head in situ (inside the glenoid fossa) without exiting the humeral head outside the glenoid socket ( Figure 10).

Figure 9. AP view of shoulder with Light Bulb appearance.

Figure 10. CT-scan of the shoulder with locking of the Humeral head inside the glenoid.

The management plan was discussed with the patient and his family, which was to try closed reduction under general anesthesia (although the rate of success is very low because of the chronicity of the case). If closed reduction fails, we proceed to open reduction.

Under General Anesthesia, closed reduction successfully reduced the head with external rotation of the Humeral Head with a snap. Examination of shoulder joint movement under anesthesia revealed a full range of movements ( Figure 11).

Figure 11. Full range of movement of shoulder joint under general anesthesia.

Subsequently, the patient wore an arm sling for two weeks, followed by exercise. MRI was performed to exclude ligament injuries.

Patient perspective

The patient and his family were very pleased with the immediate improvement following the closed reduction under anesthesia. He noted that the relief from the ‘locking’ sensation in his shoulder was a major turning point in his recovery.