The authors report an interesting case of a classical inferior dislocation of the shoulder reduced by traction and countertraction and report axillary neuropraxia though finally the patient had good results. The report highlights the classical presentation of the injury though mention has been made of the unusual presentation of inferior shoulder dislocation.

In this regard, I would like to mention other reports of inferior shoulder dislocation with unusual presentation with arm parallel to the chest wall unlike the classical presentation where the arm is parallel to the spine of scapula.^1,2,3

The mechanism of such an injury with the the arm finally resting on the chest wall has also been reported.³

I would also like to make a note on the two-step maneuver described by Nho et al.⁴ We have found it to be simple to use and without much undue stress on the shoulder and hence the neurovascular structures around it.

The authors’ report is classical and has been reported earlier in literature. A detailed illustration with post-reduction radiographs and special views to show bony defects if any or MRI to study the injury pattern of the rotator cuff or the glenoid labrum could add more information.

References:

1. Sonanis SV, Das S, Deshmukh N, Wray C: A true traumatic inferior dislocation of shoulder. Injury 2002, 33:842-844.
2. Sharma H, Denolf F: Atypical subglenoid inferior glenohumeral dislocation clinically mimicking anterior dislocation. European Journal of Trauma 2004, 4:259-261.
3. Saseendar S, Agarwal DK, Patro DK and Menon J: Unusual inferior dislocation of shoulder: reduction by two-step maneuver: a case report. Journal of Orthopaedic Surgery and Research 2009, 4:40.
4. Nho SJ, Dodson CC, Bardzik KF, Brophy RH, Domb BJ, MacGillivray JD: The two-step maneuver for closed reduction of inferior glenohumeral dislocation (luxatio erecta to anterior dislocation to reduction). J Orthop Trauma 2006, 20:354-7.

Inferior shoulder dislocation is quite uncommon but usually presents with the classical feature of overhead abduction. The traction-countertraction method has been traditionally used for reduction. However it usually requires general anesthesia and extreme forces and is likely to cause stretch inkury to neurovascular structures. We found the two-step maneuver proposed by Nho et al to be easy and executable with a single physician.