According to a new study published in the October 2012 issue of the Journal of the American Academy of Orthopaedic Surgeons, shoulder dislocation rates are about the same in younger and older people, but injuries in older patients are more likely to be overlooked or misdiagnosed, which can mean years of pain and disability. “Older patients are much more likely to experience injury to the rotator cuff, the group of tendons, ligaments and other structures that help give the shoulder its range of motion,” said study lead author Anand Murthi, MD. “This is because the rotator cuff tissue becomes weaker and more brittle as a result of aging and therefore tears more easily. By comparison, younger patients with healthier, stronger rotator cuff tissues are more likely to experience injury in other areas of the shoulder. Unfortunately, although rotator cuff tears are common in older patients, they are often missed.”
Older people may also be reluctant to have surgery, he added. Using conservative treatment, like anti-inflammatory drugs and cortisone injections, can offer temporary relief, but don’t treat the underlying reason for the pain. There is some good news for the older population: People over 40 who have a shoulder dislocation are less likely than younger patients to have a recurrence because the rotator cuff, which is most commonly injured in older patients, plays a minimal role in shoulder stability.
Research highlighted these facts:
• About one-fifth of shoulder dislocations occur in people age 60 and over.
• The rate of recurrent shoulder dislocations occur in as many as 90 percent of patients in their 20s and 30s, but in less than 10 percent of patients aged 40 and older.
• Differences in the way injuries affect the shoulder components are largely responsible for the increased incidence of recurrence in younger patients, as well as the increased incidence of rotator cuff tears in older patients.
• In people 60 and older, the incidence of rotator cuff tears in shoulder dislocation ranges from 35 percent to 86 percent.
Know the Signs
Symptoms like persistent pain or tenderness, the inability to raise your arm with the shoulder, tingling in a hand, weakness or decreased temperature in an arm or hand and the lack of or a diminished sensation in or near the injured area may indicate an injury that isn’t fully healed. “If older patients have shoulder pain that is not relieved with rest, ice and anti-inflammatories, they should seek out treatment by a shoulder specialist or orthopedic surgeon,” Dr. Murthi said. “This is especially true if they’ve recently had trauma to the shoulder.”
Take steps to prevent an injury from occurring in the first place. “Older patients can maintain their flexibility with a good stretching program, especially if they develop stiffness, which often leads to pain and dysfunction,” said Dr. Murthi. “Fall prevention is also very important in the older population, as traumatic shoulder injuries and shoulder dislocations from falls can lead to traumatic rotator cuff tears. Older patients often let these injuries wait for treatment, but early diagnosis and repair of these injuries are the key components to ensuring these patients have the best outcomes possible. With careful evaluation and management, including physical therapy as needed, most older patients can expect to return to the level of activity they enjoyed prior to their shoulder injury.”