Prevalence and effects of shoulder dislocation in the elderly

Recurrent dislocation of the shoulder has been extensively studied in young and middle-aged patients, whereas little intrarotation is available from elderly patients. Material and methods: We analyzed the clinical records of all patients older than 60 years, who had been treated for a primary dislocation of the shoulder at our department between 1988 and 1990. There were 121 patients, representing 24% of all subjects treated in the same period for primary dislocation of the shoulder. Thirteen patients had died in the follow-up period, thus leaving 104 cases which were entered into the study. There were 85 females (82%) and 19 males (18%), aged 61 to 89 years (mean 73 years); the right shoulder was involved in 35 cases, and the left in 69. Two out of 121 patients had a posterior dislocation, in one the dislocation was diagnosed only after three months, In 39 patients (37.5%) the dislocation had occurred on the dominant side. A concomitant fracture of the greater tuberosity had occurred in 13 patients (12.5%). The arm waj; immobilized in adduction and internal rotation for 2-4 weeks. The mean follow-up was 5.2 years (range 6.2-7.6 years). All patients were interviewed and examined and 28 underwent MRl or arthrography of the involved. Results: Recurrent dislocation occurred in 21 patients (20%), none of whom had had a fracture of the greater tuberosity. One recurrence occurred in 11 patients after a mean time of 21 months (range 0.3-3 years) and two recurrences occurred in 5 patients with an interval of about one year (range, 0.9-1.2 years) between the dislocations; 5 patients had numerous dislocations with a mean interval of 6.4 months between the recurrences. The mean age of the 21 patients with recurrences was 68 years and that of the patients with two or more dislocations was 69 years, Of the 91 patients with no associated fracture, 688 had a limited range of motion and 60, including all those with recurrences of dislocation, had clinical evidence of a cuff tear. Imaging studies demonstrated a cuff tear in 22 out of 25 patients. Of the 13 patients with a fracture of the greater tuberosity. Eleven had a limited range of motion and one showed clinical signs of a cuff tear. In none of the three patients undergoing imaging studies was there evidence of a cuff tear. One of the two patients with a primary posterior dislocation had a good range of motion and had had no recurrences. The patient who had an initially undiagnosed dislocation underwent shoulder arthroplasty. Conclusions: A quarter of the patients with a primary anterior shoulder dislocation were older than 60. Twenty percent of elderly patients who underwent an anterior shoulder dislocation subsequently have one or more dislocations and 5% had frequent recurrences. Over 60 years old. patient age does not influence the tendency to recurrence. An associated fracture of the greater tuberosity considerably decreases or eliminates the risk of recurrence. More than two-thirds of our patients with no associated fracture, and all those with recurrence, showed evidence of a cuff tear.