Treatment of Traumatic Anterior Shoulder Dislocation in Patients Older Than 60 Years

Abstract

Background: The prevalence of traumatic anterior shoulder dislocation in the elderly population has increased; however, no consensus has been reached regarding the management of shoulder dislocations in elderly patients. Purpose: This study investigated the clinical manifestations of traumatic anterior shoulder dislocation in patients older than 60 years and evaluated the functional outcomes of different treatment modalities based on associated abnormalities and the number of dislocations. Study Design: Case series; Level of evidence, 4. Methods: Sixty-seven patients older than 60 at the time of primary shoulder dislocation were included. Magnetic resonance imaging or ultrasonography was performed on all patients to confirm associated injuries. Fifty-two patients were treated for primary shoulder dislocation and 15 for recurrent dislocation. Results: Postinjury examinations revealed no associated injuries in 31 patients with primary shoulder dislocation; these patients recovered shoulder function after rehabilitation (American Shoulder and Elbow Surgeons [ASES] score: 93 ± 6; Constant score: 89 ± 8). For the other 36 patients, 33 were found to have rotator cuff tears (isolated cuff tears in 16), and 3 were found to have an isolated Bankart lesion. The average ASES score of the 17 patients with primary shoulder dislocation who were treated operatively was 83 ± 10, and the average Constant score was 78 ± 13 at final follow-up. The average ASES score of patients with recurrent shoulder dislocation was 89 ± 9, and the average Constant score was 84 ± 13. No statistically significant differences in functional shoulder outcomes between patients with primary and recurrent dislocation were evident (P > .05). However, patients who were treated nonoperatively showed significantly better recovery of shoulder function than patients who were treated operatively regardless of the number of dislocations (P < .001). No recurrent shoulder dislocation was observed in any patient during an average follow-up period of 55 months. Conclusion: The accurate diagnosis of associated injuries after traumatic anterior shoulder dislocation in patients older than 60 is critical for the recovery of shoulder function because more than half of patients had rotator cuff tears or anterior capsulolabral lesions, which may lead to recurrent shoulder dislocation. Satisfactory clinical outcomes without recurrence were obtained after early detection of abnormalities and different treatment modalities based on associated injuries and the number of dislocations experienced.