title: Tragic result of traditional Chinese medicine manipulation: an unusual case report of bilateral anterior shoulder dislocations.
abstract: BACKGROUND
  In Taiwan, there is a good universal healthcare system to the patients; however, the majority of Taiwanese seek the complementary and alternative medicine when they are injured or ill. The traditional Chinese medicine, which is a branch of complementary alternative medicine, is prevalent in Taiwan. Without proper sequence of maneuvers, either traditional Chinese medicine or conventional medicine might cause unexpected complications. We report a case of 76-year-old woman who was manipulated by a bonesetter, leading to bilateral anterior shoulder dislocations. To the authors' best knowledge, this injury mechanism of bilateral shoulder dislocations has not been reported in the literature. Since the traditional Chinese medicine is popular in Taiwan, proper training with better skills for the practitioners should be emphasized. We highlight the integration and collaboration of traditional Chinese medicine with western medicine to achieve a better health care for the patients.
  
  
  METHODS
  A 76-year-old Taiwanese woman has been suffering from soreness and stiffness of bilateral shoulders for 6 months. She went to a bonesetter for mobilization for her shoulders. After manipulations for bilateral shoulders, the woman experienced locked both shoulders with sharp pain. She came to our institute, where the radiographs confirmed bilateral anterior shoulder dislocations. Closed reduction for the dislocations was done by the physician. The patient returned to good range of motion of bilateral shoulders after subsequent rehabilitation without any neurologic deficits.
  
  
  CONCLUSIONS
  To the authors' best knowledge, this unusual injury of bilateral anterior shoulder dislocations had not been reported. The possible mechanism of this injury and the health belief of traditional Chinese medicine in Taiwan are discussed. Improper shoulder manipulations would lead to unexpected complication in any medical practices. We suggest that both traditional Chinese medicine and conventional medicine should follow specific sequences of manipulations; Collaboration and integration with each other could achieve a better healthcare for the patients.
authors.affiliation: Department of Orthopedics, Changhua Christian Hospital, No.135, Nanxiao St., Changhua City, Changhua County 500, Taiwan. 111111@cch.org.tw.|Department of Healthcare Administration, Asia University, No.500, Liufeng Rd., Wufeng Dist., Taichung City, 413, Taiwan. 111111@cch.org.tw.
authors.forename: Chiu-Liang
authors.initials: CL
authors.lastname: Chen
authors.affiliation: Department of Ophthalmology, Changhua Christian Hospital, No.135, Nanxiao St., Changhua City, Changhua County 500, Taiwan. 63040@cch.org.tw.|Department of Healthcare Administration, Asia University, No.500, Liufeng Rd., Wufeng Dist., Taichung City, 413, Taiwan. 63040@cch.org.tw.
authors.forename: Shin-Lin
authors.initials: SL
authors.lastname: Chiu
authors.affiliation: Department of Healthcare Administration, Asia University, No.500, Liufeng Rd., Wufeng Dist., Taichung City, 413, Taiwan. chiaolee@asia.edu.tw.
authors.forename: Chiao-Lee
authors.initials: CL
authors.lastname: Chu
authors.affiliation: Department of Healthcare Administration, Asia University, No.500, Liufeng Rd., Wufeng Dist., Taichung City, 413, Taiwan. sjlan@asia.edu.tw.
authors.forename: Shou-Jen
authors.initials: SJ
authors.lastname: Lan
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008516:Medicine, Chinese Traditional / Q000009:adverse effects*; D026201:Musculoskeletal Manipulations / Q000009:adverse effects*; D026741:Physical Therapy Modalities / Q000009:adverse effects*; D016059:Range of Motion, Articular; D012783:Shoulder Dislocation / Q000209:etiology*; D013624:Taiwan