Shoulder Instability in Older Patients

Glenohumeral instability has a bimodal age distribution, with most affected patients younger than 40 years, but with a second peak in older patients. Glenohumeral dislocations in older patients often present with complex injury patterns, including rotator cuff tears, fractures, and neurovascular injuries. Glenohumeral instability in patients older than 40 years requires a different approach to treatment. An algorithmic approach aids the surgeon in the stepwise decision-making process necessary to treat this injury pattern.

Key points

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Shoulder instability in the older patient has a lower recurrence rate (0%–31%) compared with high recurrence rates in younger patients.
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Shoulder dislocations in older patients are more likely to be associated with fractures, neurovascular injuries, and rotator cuff tears.
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An older patient with inability to lift the arm after an anterior shoulder dislocation likely has a rotator cuff tear, as opposed to a nerve injury.
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Treatment of posterior shoulder instability in the older patient often presents as a chronic dislocation and depends more on length of time from injury and amount of humeral bone loss.