Shoulder Dislocation in Older Patients Less Likely to be Diagnosed, Treated

A new study shows that shoulder dislocation in older patients is more likely to be overlooked or misdiagnosed than among younger patients. The study warned that older patients whose shoulder injuries are not treated can face years of persistent pain and disability.

Published in the October 2012 issue of the Journal of the American Academy of Orthopaedic Surgeons, the study examines the differences in dislocation injuries between older and younger patients. It also suggests an approach to evaluate older patients that could help improve diagnosis and management of related injuries.

The study’s lead author is Dr. Anand Murthi. He says understanding the very different ways shoulder dislocation can affect patients over 40 years of age is the first step in making an accurate diagnosis of dislocation-related injuries. Older patients are more likely to experience injury to the rotator cuff, which is the group of tendons, ligaments and other structures that help give the shoulder its range of motion, Dr. Murthi explained. He said this happens because the rotator cuff tissue becomes weaker and more brittle with aging and tears more easily.

Older patients may also be reluctant to undergo surgery, he added. This often results in more conservative treatment with anti-inflammatory drugs and cortisone injections. These can temporarily provide relief, but they do not treat the underlying cause.

About one-fifth of shoulder dislocations occur in patients 60 years or older, the study found. Repeated 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, the study found.

In older patients aged 60 and older, the incidence of rotator cuff tears in shoulder dislocation ranges from 35 percent to 86 percent.

Doctors say some of the increase in injuries is a result of a more active older patient population today than in the same age group a decade ago. Careful evaluation of all shoulder injuries in this group is important to avoid mismanagement of the injuries.

Symptoms of a shoulder injury include persistent pain or tenderness, inability to raise the arm with the shoulder, tingling in the hand, weakness or decreased temperature in the arm or hand, and lack of or diminished sensation in or near the injured area may indicate that the injuries are not fully healed. Dr. Murtha recommended seeing a shoulder specialist if pain persists despite treatment with ice, rest and pain medication.

He recommended preventing injury through a stretching program. Also, patients who are older should try to protect themselves from falling, since falls can cause shoulder injuries. The other problem is that older patients often delay treatment following an injury. Patients who feel they may have a rotator cuff injury can often return to the level of activity they enjoyed prior to their shoulder injury if they undertake a quality program of physical therapy.

Kreisman Law Offices has been handling medical malpractice and misdiagnosis lawsuits for over 36 years, serving those areas in and around Cook County, including Wilmette, Lisle, Blue Island, and Barrington.
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