A 20something year old male with a history of polycythemia vera on apixaban, right above knee amputation, and seizure disorder presents with bilateral shoulder pain. The patient adamantly denies any trauma or etiology of his pain. He states the right is worse than the left and he denies any other complaints. On physical exam, his heart rate is 132 and his other vital signs are stable. He has significant ecchymosis of his right shoulder. He is unable to move or range either shoulder and his strength and neurovascular exam is grossly normal from his elbow down.

Initial radiographs of the right shoulder demonstrates a comminuted humeral head fracture with posterior displacement of the primary fragment. His left shoulder demonstrates a minimally displaced surgical neck fracture of the proximal humerus, possibly subacute. Orthopedics was consulted and he was admitted to the hospital.

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