Shoulder Dislocation Over 35 Years Old: Spectrum of Arthroscopic Pathoanatomy (SS-05)

Abstract

Traumatic shoulder dislocation in older patients is associated with a high incidence of rotator cuff injury. However, associated intraarticular pathoanatomy in this group of patients has not been well described. The purpose of this study is to review the arthroscopic findings in patients with anterior shoulder dislocation over age 35 years old. Patients over 35 years old, with a history of recent traumatic anterior shoulder dislocation, and symptoms requiring surgical intervention were included. Individuals with posterior instability, major fractures, multidirectional instability, or prior history of dislocation before age 35 were excluded. All patients underwent a period of nonoperative rehabilitation, and individuals not requiring intervention for either continued symptomatic pain or instability were excluded. Operative reports, and arthroscopic video were reviewed for pathoanatomical findings. 17 patients met inclusion criteria. There were 14 males and three females. Age range was 37-71 years old. Four had recurrent instability, and 10 had pain only. Three had pain and instability. There were 11 full thickness rotator cuff tears (RCT), and all were repaired. Eight shoulders had Bankart lesions (6 repaired, one bony), two had type II SLAP lesions (both repaired), there was one long head biceps rupture, and three demonstrated humeral avulsion of the glenohumeral ligament (two repaired open). All shoulders demonstrated Hill-Sachs lesions of various size and depth. During this three year time period, six patients with dislocation were treated without surgery due to successful nonoperative treatment. Shoulder dislocation in the older patient may result in a wide array of pathologic findings encountered during arthroscopic evaluation. RCT incidence requiring repair was 61%. Clinical instability and capsulolabral tears are variable. These are not necessarily correlated with surgical findings. The incidence of HAGL lesion was higher than expected in this small series. Arthroscopy is useful for identifying all associated pathology in this patient group, but was not provided unless patients remained clinically symptomatic. The surgeon should be aware of the variable nature of the injury and the diversity of the clinical presentation.