Treatment of primary anterior shoulder dislocation in patients older than 40 years of age. Conservative versus operative.

Primary shoulder dislocation in patients older than 40 years of age is frequently benign, but may be associated with significant rotator cuff or nerve injury. A series of such patients was observed to determine an effective treatment algorithm. Treatment of those dislocations associated with fractures of the greater tuberosity was determined by the fracture pattern. Four patients with glenoid fractures were all treated operatively. Patients without associated fractures were classified according to the absence or presence of significant pain or weakness after 3 weeks. Of 27 patients who were symptom free at 3 weeks, only four had associated problems after 3 months. All of 13 patients complaining of weakness or pain after 3 weeks had significant associated lesions (11 rotator cuff tears, 2 cuff tears plus neurologic deficit). The persistence of significant pain or weakness 3 weeks after primary dislocation in this age group is an indication for further investigation (arthrography or ultrasound). While recurrent instability is relatively uncommon, rotator cuff repair when appropriate in medically fit patients resulted in pain relief and return of strength.