Primary traumatic anterior shoulder dislocation in patients 40 years of age and older

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.