Bilateral anterior glenohumeral dislocation and coracoid processes fracture after seizure: acute MRI findings of this rare association ☆ Atul Kumar Taneja a, b, ⁎, Luis Pecci Neto a, c , Abdalla Skaf a, c a Departamento de Radiologia Musculoesquelética, Hospital do Coração (HCor) and Teleimagem, São Paulo, Brazil b Musculoskeletal Imaging and Intervention Division, Massachusetts General Hospital and Harvard Medical School, Boston, USA c Alta Diagnósticos, São Paulo, Brazil abstract article info Article history: Received 10 April 2013 Received in revised form 20 June 2013 Accepted 1 August 2013 Keywords: Shoulder dislocation Coracoid process Fracture Seizure MRI We report a rare case of bilateral anterior shoulder dislocation associated with coracoid processes fracture after a seizure episode in a 37-year-old woman. This combination of findings is rare, especially by the presence of bilateral coracoid processes fracture. Possible mechanisms related are direct trauma of humeral heads over the coracoid processes or sudden pull of biceps short head attachment site during uncontrolled contractures. Few reports published similar combination of injuries, and to our knowledge, this is the first to demonstrate its acute features by magnetic resonance imaging. A review of the literature is also presented. © 2013 Elsevier Inc. All rights reserved. 1. Introduction We report a case of acute bilateral anterior glenohumeral dislocation with coracoid processes fractures due to a generalized tonic–clonic seizure (GTCS) episode. Bilateral anterior shoulder dislocation may occur after violent trauma, electrocution, or seizures. Coracoid fractures are uncommon and hardly occur in association with glenohumeral dislocations, being usually caused by direct trauma [1,2]. Two mechanisms have been proposed to explain fracture of the coracoid process when shoulder dislocates: the first is an avulsion of the coracoid process tip from a violent contraction of the muscles attached, and the second is a direct impact of the humeral head over the coracoid process during dislocation [2–4]. Similar fractures might be undetected by radiographs only [1,3]. There are scarce published reports of such association of injuries [1,2], and to our knowledge, this is the first to demonstrate its acute magnetic resonance imaging (MRI) findings. 2. Case report A 37-year-old woman presented with 15 days of persistent bilateral shoulder pain after a first-time episode of GTCS. She reported having bilateral shoulder dislocation during the episode, which was reduced the same day under local anesthesia by an orthopedic surgeon at another health facility, followed by application of bilateral sling. Clinical examination revealed tenderness over humeral heads and anteromedial region of both shoulders, as well as restricted range of motion due to pain during shoulder maneuvers. No neurological or vascular deficits were present. Despite past history of cesarean surgery and umbilical hernia surgical correction, she was otherwise healthy, without any history of serious musculoskeletal injury, systemic disease, or bone disorder. Plain radiographs of the shoulders performed at another facility during the day of the seizure were not available. MRI scan of both shoulders were performed at our institution using the following pulse sequences: axial proton-density (PD) weighted fat-suppressed [rep- etition time/echo time=2566/44; number of excitations (NEX)=2; slice thickness=4.0 mm; matrix=288×224], sagittal T1-weighted (316/9; NEX 1; 4.0 mm; 288×224), sagittal PD-weighted fat- suppressed (1950/35; 1.5; 4.0 mm; 288×224), coronal T1-weighted (350/9; NEX 1; 4.0 mm; 288×256), and coronal PD-weighted fat- suppressed (1700/33; 1.5; 4.0 mm; 256×256). MRI revealed similar findings on both shoulders. Acute Hill–Sachs lesions were demonstrated by cortical depression on posterolateral aspect of both humeral heads, with extensive bone marrow edema, as a result of bilateral anterior glenohumeral dislocation (Fig. 1). Also, bilateral sprain of the anterior component of inferior glenohumeral ligament (defined by intrasubstance and periligamentous edema without discontinuity) and tear of anteroinferior glenoid labrum were noted, the latter presenting as linear tear of the labrum on the right Clinical Imaging 37 (2013) 1131–1134 ☆ Disclosure: No conflicts of interest. ⁎ Corresponding author. Departamento de Radiologia Musculoesquelética, Hospital do Coração (HCor) and Teleimagem, Rua Desembargador Eliseu Guilherme. E-mail address: tanejamsk@gmail.com (A.K. Taneja). 0899-7071/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.clinimag.2013.08.007 Contents lists available at ScienceDirect Clinical Imaging journal homepage: http://www.clinicalimaging.org