Shoulder Injuries in Patients with Epilepsy – a Multidisciplinary Approach

Abstract

The management of shoulder injuries resulting from epileptic seizures presents a particular challenge. These injuries often present complex patterns, ranging from dislocations and fractures to damage to the rotator cuff. Recurrent seizures can significantly impact the outcome and must be considered a central risk factor when choosing the therapeutic approach. Accordingly, these injuries require close multidisciplinary cooperation between orthopaedics/trauma surgery, neurology/epileptology and physiotherapy, both in diagnosis and treatment. Despite their clinical relevance, standardised treatment algorithms are currently lacking, and the available scientific evidence remains limited. This review article addresses the specific characteristics of seizure-related shoulder injuries within a multidisciplinary approach. Epidemiological aspects, including pathomechanical principles, diagnostic challenges, and current conservative and surgical treatment options, are discussed.

Shoulder injuries in patients with epilepsy – facts to go!

• Need for interdisciplinary management between orthopaedics/trauma surgery, neurology/epileptology and physiotherapy

• Recurrence is the main risk factor for the success of therapy

  1. Consideration of the indication for antiseizure medication after a first seizure; if necessary, adjustment of therapy for chronic epilepsy

  2. Avoiding potentially provocative factors

• Seizure control is critical!

• Consideration of specific pathology – including deeper and larger Hill-Sachs lesions than in classic traumatic dislocations

• Individual treatment choice taking into account the underlying pathology, seizure activity, functional demands and compliance

• Conservative therapy often yields inadequate results

• Bone stabilisations are superior to soft tissue procedures for seizure-related instability.

• Postoperative neurological/epileptological care with the aim of the best possible seizure control as an integral part of surgical management

Schulterverletzungen bei Patienten mit Epilepsie – Facts to go!

• Notwendigkeit eines interdisziplinären Managements zwischen Orthopädie/Unfallchirurgie, Neurologie/Epileptologie und Physiotherapie

• zentraler Risikofaktor des Therapieerfolges ist der Rezidivanfall

  1. Indikationsprüfung einer antisuppressiven Medikation nach einem ersten Anfall, ggf. Therapieanpassung bei chronischer Epilepsie

  2. Vermeidung potenzieller Provokationsfaktoren

  3. Förderung der Compliance

• Die Anfallskontrolle ist entscheidend!

• Berücksichtigung der spezifischen Pathologie – u. a. tiefere und größere Hill-Sachs Läsionen als klassisch traumatische Luxationen

• Individuelle Therapiewahl unter Berücksichtigung der zugrunde liegenden Pathologie, Anfallsaktivität sowie funktionellen Anspruch und Compliance

• Konservative Therapie zeigt oft unzureichende Ergebnisse

• Knöcherne Stabilisierungen sind weichteiligen Verfahren bei anfallsbedingter Instabilität überlegen – Prüfung alternativer Knochengrafts

• Postoperativ neurologische/epileptologische Betreuung mit dem Ziel der bestmöglichen Anfallskontrolle als integraler Bestandteil des operativen Managements

Keywords

epilepsy - shoulder dislocation - shoulder - seizure - instability

Publication History

Received: 30 July 2025

Accepted: 01 October 2025

Article published online:
19 January 2026

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