{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T03:44:57Z","timestamp":1760240697886,"version":"build-2065373602"},"reference-count":25,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2019,8,25]],"date-time":"2019-08-25T00:00:00Z","timestamp":1566691200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background: Cycling is a popular source of recreation and physical activity for children and adults. With regard to the total number of sports injuries, cycling has the highest absolute number of injuries per year in the United States population. Cycling injuries can be classified into bicycle contact, traumatic, or overuse injuries. Aim of this study: The aims of this case report are to report a rare clinical complication of glenohumeral joint anterior dislocation that resulted in a patient experiencing continuous GHJ dislocations secondary to involuntary violent muscular spasms and emphasize the role of the physical therapist\u2019s differential diagnosis and clinical decision-making process in a patient following direct access referral. Case presentation: A professional 23-year-old cyclist presented to a physical therapist with spontaneous multidirectional dislocations to the right shoulder after the recurrence of trauma occurred during a recent cycling race. The dislocations do not occur at night, but occur during the day, randomly, and mostly associated with changes in the patient\u2019s psychological conditions. Directly from the clinical history, the physical therapist identified a neuro-physiological orange flag as well as an orthopedic red flag and, therefore, decided it was appropriate to refer the patient to a neurologist. It was determined by the physical therapist to be a priority to focus on the patient\u2019s neurologic status and then to evaluate the orthopedic problem. The neurological examination revealed a condition of spontaneous multidirectional dislocation associated with recurrent antero-posterior pain spasms of the shoulder joint. The neurologist prescribed medication. Following the second cycle of medication assumption, the patient was able to continue physiotherapy treatment and was referred to the orthopedic specialist to proceed with shoulder stabilization surgery. Discussion and conclusion: Currently, the diagnosis of this unusual clinical condition is still unclear. It is a shared opinion of the authors that the trauma during the past bicycle race awakened an underlying psychological problem of the patient that resulted in a clinical condition of weakness of all the structures of the shoulder, such that these spasms could result in multiple multidirectional dislocations.<\/jats:p>","DOI":"10.3390\/medicina55090529","type":"journal-article","created":{"date-parts":[[2019,8,26]],"date-time":"2019-08-26T04:38:23Z","timestamp":1566794303000},"page":"529","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A Rare Consequence after Shoulder Dislocation in a Professional Cyclist: A Case Report"],"prefix":"10.3390","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3657-4597","authenticated-orcid":false,"given":"Claudio","family":"Ceccarelli","sequence":"first","affiliation":[{"name":"Physiotherapy and Manual Therapy, 54100 Massa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8950-8203","authenticated-orcid":false,"given":"Fabrizio","family":"Brindisino","sequence":"additional","affiliation":[{"name":"Department of Medicine and Health Science \u201cVincenzo Tiberio\u201d, University of Molise, 86100 Campobasso, Italy"},{"name":"FTM, Physiotherapy and Manual Therapy, Physiotherapy Department, 73100 Lecce, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5315-4236","authenticated-orcid":false,"given":"Mattia","family":"Salomon","sequence":"additional","affiliation":[{"name":"CST Trento S.r.l. Physiotherapy Department, 38121 Trento, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John Duane","family":"Heick","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy and Athletic Training, Northern Arizona University Flagstaff, Flagstaff, AZ 86011, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9683-9975","authenticated-orcid":false,"given":"Filippo","family":"Maselli","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa-Campus of Savona, 17100 Savona, Italy"},{"name":"Sovrintendenza Sanitaria Regionale Puglia INAIL, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,8,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.aap.2018.05.019","article-title":"Bicycle-related injuries among children treated in US emergency departments","volume":"118","author":"McAdams","year":"2018","journal-title":"Accid. 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