Irreducible shoulder dislocation in a patient with Alzheimer's disease: A case report

Introduction: Anterior shoulder dislocations are common injuries usually managed by closed reduction. However, irreducible cases, especially in elderly patients with Alzheimer's disease, complicate both diagnosis and management. Case presentation: A 78-year-old female with Alzheimer's disease presented with severe right shoulder pain and reduced function following physiotherapy. Cognitive decline complicated neurovascular assessment and communication. Radiographs identified a right anterior shoulder dislocation with a displaced greater tuberosity fracture. Multiple closed reductions under sedation were unsuccessful. Open reduction and internal fixation were performed via a deltopectoral approach. Intraoperatively, the humeral head lay above the brachial plexus, and the long head of the biceps tendon, subscapularis, and conjoint tendon obstructed reduction. These structures were released and reattached, followed by capsulorrhaphy and tuberosity fragment reduction. The joint was successfully realigned without neurovascular injury, though Alzheimer's complicates long-term prognostication. Discussion: This case demonstrates the complexity of irreducible anterior shoulder dislocations in elderly patients with cognitive impairment. Subluxation of the long head of the biceps tendon and involvement of other soft tissue and neurovascular structures can impede reduction, while forced closed attempts risk severe injury, including the brachial plexus. Early surgical intervention, guided by advanced imaging, ensures precise anatomical assessment and safer release of obstructing tissues, thereby improving overall outcomes. Conclusion: Personalized management, including timely surgical intervention, is essential. Recognizing when standard non-invasive methods are insufficient enables prompt correction and appropriate rehabilitation. This case underscores the importance of a comprehensive, individualized approach to ensure better outcomes, patient satisfaction, and extended long-term care in elderly patients with significant cognitive impairments.