title: Primary traumatic anterior shoulder dislocation in patients 40 years of age and older.
abstract: During three consecutive ski seasons (1991 to 1994), 125 patients 40 years of age and older without previous shoulder injuries or surgery sustained a traumatic first-time anterior shoulder dislocation. At a minimum of 2 years' follow-up, patients were contacted to determine long-term outcome and to identify factors leading to prolonged morbidity or the need for surgical intervention. Fifty-two patients were available for interview. A modified Rowe shoulder score showed 32 excellent, nine good, eight fair, and three poor results. Eighteen (35%) rotator cuff tears were subsequently identified, with only 11 (61%) of these patients obtaining an excellent or good outcome (P = .011). Of the 11 patients with a fair or poor result, seven (64%) had a rotator cuff tear. Of the 12 patients with isolated cuff tears, 84% had an excellent or good result when treated surgically, compared with 50% when treated nonsurgically. Our findings indicate that recurrence is not a frequent complication of traumatic anterior shoulder dislocation in this age-group (4%). However, prolonged morbidity secondary to rotator cuff tear is more prevalent than in a younger population. We believe early diagnosis of rotator cuff pathology by either magnetic resonance imaging (MRI) or arthrogram with subsequent surgical repair can lead to faster restoration of function and a better outcome in these select individuals.
authors.affiliation: Orthopaedic Associates of Aspen & Glenwood, Aspen, Colorado 81611, USA.
authors.forename: T
authors.initials: T
authors.lastname: Pevny
authors.forename: R E
authors.initials: RE
authors.lastname: Hunter
authors.forename: J R
authors.initials: JR
authors.lastname: Freeman
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D017006:Rotator Cuff / Q000601:surgery; D000070636:Rotator Cuff Injuries; D012783:Shoulder Dislocation / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D012865:Skiing / Q000293:injuries*; D016896:Treatment Outcome