title: Rotator cuff tear and glenohumeral instability : a systematic review.
abstract: BACKGROUND
  The rotator cuff plays a significant role in the static and dynamic stability of the glenohumeral joint. Rotator cuff tears may occur after shoulder dislocations, whether in younger athletes or older patients with age-related tendon degeneration. Untreated tears may cause persistent pain, dysfunction, instability, and degenerative changes. A thorough understanding of when to look for rotator cuff tears after shoulder dislocations and how best to manage them may decrease patients' pain and improve function.
  
  
  OBJECTIVE
  We systematically reviewed the available literature to better understand (1) when a rotator cuff tear should be suspected after a dislocation, (2) whether surgical or nonsurgical approaches result in better scores for pain and satisfaction in patients with rotator cuff tears resulting from shoulder dislocations, and (3) whether intraarticular lesions, rotator cuff tears, or both should be addressed when surgery is performed.
  
  
  METHODS
  We systematically searched MEDLINE(®), CINAHL, and EMBASE for studies published from 1950 to 2012. We included studies reporting outcomes after treatment in patients with rotator cuff tears and shoulder dislocations. We excluded case reports, studies without any treatment, and studies about patients treated with arthroplasty. Five Level III and six Level IV studies were ultimately selected for review.
  
  
  RESULTS
  Patients with persistent pain or dysfunction after a shoulder dislocation often had a concomitant rotator cuff tear. Surgical repair resulted in improved pain relief and patient satisfaction compared to nonoperative management. Repair of the rotator cuff, along with concomitant capsulolabral lesions, helped restore shoulder stability. While these findings are based on Level III and IV evidence, better long-term studies with larger cohorts are needed to strengthen evidence-based recommendations.
  
  
  CONCLUSIONS
  Persistent pain and dysfunction after a shoulder dislocation should prompt evaluation of the rotator cuff, especially in contact or overhead athletes, patients older than 40 years, or those with nerve injury. Surgery should be considered in the appropriately active patient with a rotator cuff tear after dislocation. While the current literature suggests improved stability and function after surgical repair of the rotator cuff, higher-quality prospective studies are necessary to make definitive conclusions.
authors.forename: Mufaddal Mustafa
authors.initials: MM
authors.lastname: Gombera
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan, MedSport, 24 Frank Lloyd Wright Drive, Lobby A, PO Box 0391, Ann Arbor, MI, 48106-0391, USA.
authors.forename: M Mustafa
authors.initials: MM
authors.lastname: Gomberawalla
authors.forename: Jon K
authors.initials: JK
authors.lastname: Sekiya
mesh_terms: D001696:Biomechanical Phenomena; D006801:Humans; D007593:Joint Instability / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D010146:Pain / Q000209:etiology; D017060:Patient Satisfaction; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012307:Risk Factors; D017006:Rotator Cuff / Q000503:physiopathology / Q000601:surgery; D000070636:Rotator Cuff Injuries; D012783:Shoulder Dislocation / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012785:Shoulder Joint / Q000503:physiopathology*; D013708:Tendon Injuries / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome
references.citation: J Shoulder Elbow Surg. 2006 Mar-Apr;15(2):148-53
references.pmid: 16517356
references.citation: Bull Hosp Jt Dis. 2005;62(3-4):99-101
references.pmid: 16022221
references.citation: Clin Orthop Relat Res. 1993 Jun;(291):20-8
references.pmid: 8504601
references.citation: Am J Sports Med. 2007 Jan;35(1):131-44
references.pmid: 17130247
references.citation: Clin Orthop Relat Res. 1993 Jun;(291):103-6
references.pmid: 8504589
references.citation: J Shoulder Elbow Surg. 1999 May-Jun;8(3):220-5
references.pmid: 10389076
references.citation: Clin Orthop Relat Res. 1984 Nov;(190):212-6
references.pmid: 6488634
references.citation: Clin Orthop Relat Res. 1983 Jun;(176):181-5
references.pmid: 6851323
references.citation: Arthroscopy. 2011 May;27(5):681-94
references.pmid: 21663724
references.citation: J Bone Joint Surg Am. 2000 Jun;82(6):849-57
references.pmid: 10859105
references.citation: Clin Orthop Relat Res. 1986 May;(206):192-5
references.pmid: 3708974
references.citation: J Bone Joint Surg Am. 1983 Mar;65(3):343-9
references.pmid: 6826597
references.citation: J Bone Joint Surg Am. 1988 Feb;70(2):227-32
references.pmid: 3343267
references.citation: Rev Rhum Mal Osteoartic. 1990 Mar;57(3):189-91
references.pmid: 2339266
references.citation: J Shoulder Elbow Surg. 1995 Jan-Feb;4(1 Pt 1):51-3
references.pmid: 7874565
references.citation: Clin Orthop Relat Res. 1983 May;(175):18-24
references.pmid: 6839586
references.citation: Arch Orthop Trauma Surg. 2006 May;126(4):235-40
references.pmid: 16151824
references.citation: Sports Med Arthrosc Rev. 2011 Dec;19(4):395-400
references.pmid: 22089289
references.citation: J Bone Joint Surg Am. 1996 Nov;78(11):1677-84
references.pmid: 8934481
references.citation: J Bone Joint Surg Am. 1996 Jan;78(1):94-102
references.pmid: 8550685
references.citation: Clin Orthop Relat Res. 1996 Sep;(330):13-30
references.pmid: 8804270
references.citation: Clin Orthop Relat Res. 1991 Feb;(263):128-34
references.pmid: 1993366
references.citation: Arthroscopy. 1998 Apr;14(3):289-94
references.pmid: 9586975
references.citation: Am J Sports Med. 2010 Sep;38(9):1795-803
references.pmid: 20566721
references.citation: J Shoulder Elbow Surg. 2012 Nov;21(11):e6-9
references.pmid: 22999849
references.citation: Acta Orthop Scand. 1993 Oct;64(5):549-52
references.pmid: 8237322
references.citation: J Shoulder Elbow Surg. 2001 Jan-Feb;10(1):73-84
references.pmid: 11182740
references.citation: Med Sport Sci. 2012;57:41-52
references.pmid: 21986044
references.citation: Arthroscopy. 2006 Jul;22(7):728-35
references.pmid: 16843808
references.citation: Orthopade. 2009 Jan;38(1):70-4
references.pmid: 19139844
references.citation: Clin Orthop Relat Res. 1994 Jul;(304):74-7
references.pmid: 8020237
references.citation: Arthroscopy. 2006 Mar;22(3):270-6
references.pmid: 16517310
references.citation: J Bone Joint Surg Am. 1956 Oct;38-A(5):957-77
references.pmid: 13367074
references.citation: Clin Sports Med. 1991 Oct;10(4):783-8
references.pmid: 1934096
references.citation: Am J Sports Med. 1994 Jan-Feb;22(1):121-30
references.pmid: 8129095
references.citation: Unfallchirurg. 2001 Feb;104(2):115-8
references.pmid: 11471403
references.citation: J Bone Joint Surg Br. 1990 Jan;72(1):68-71
references.pmid: 2298797
references.citation: Am J Sports Med. 2007 Jul;35(7):1174-9
references.pmid: 17387217
references.citation: Br J Sports Med. 2003 Apr;37(2):179-81; discussion 181
references.pmid: 12663364
references.citation: J Shoulder Elbow Surg. 1999 May-Jun;8(3):259-65
references.pmid: 10389083
references.citation: J Shoulder Elbow Surg. 1993 Jan;2(1):27-35
references.pmid: 22959294