The Skydiver’s Shoulder: An Unexpected Twist

HISTORY: A 57-year-old male with a history of a previous right shoulder anterior dislocation 25 years ago presented to the emergency department with right shoulder pain and limited range of motion after participating in an indoor skydiving session. During the activity, he reported a sudden, intense pain in his right shoulder as he tried to stabilize himself against the powerful airflow in the wind tunnel. He noticed his arm was immobile above his head. The patient denied any history of shoulder surgeries. PHYSICAL EXAMINATION: On examination, the shoulder was deformed, held in an abducted and externally rotated position, with the humeral head palpably displaced in the axilla. A neurovascular exam showed normal distal pulses and intact sensory and motor function in the right arm. DIFFERENTIAL DIAGNOSIS: Inferior shoulder dislocation (luxatio erecta) - Anterior shoulder dislocation - Posterior shoulder dislocation - Rotator cuff injury - Shoulder fracture TEST AND RESULTS: Standard anteroposterior (AP) and lateral radiographs of the right shoulder were performed. - Imaging revealed an inferior dislocation of the humeral head relative to the glenoid fossa, confirming an inferior dislocation without evidence of an acute fracture. FINAL WORKING DIAGNOSIS:- Inferior shoulder dislocation (luxatio erecta) TREATMENT AND OUTCOMES: The patient was initially given 5 mg of Valium for pain relief and mild sedation, and a closed reduction attempt using traction-countertraction was performed. This initial reduction attempt was unsuccessful, as the humeral head remained inferior to the glenoid. A second reduction attempt under conscious sedation with etomidate was planned. However, before the medication could be administered, the patient felt a sudden “pop” in his shoulder with immediate pain relief, suggesting spontaneous reduction. A re-examination showed an improved range of motion, and repeat radiographs confirmed the humeral head was correctly repositioned within the glenoid without fractures or additional injuries. The patient was provided with a shoulder sling for immobilization, pain management, and instructed to follow up with orthopedic care. Conservative management and physical therapy were recommended, leading to a full recovery.