Recurrent instability of the shoulder after age 40.

Twelve patients who had recurrent instability of the shoulder with onset after age 40 were reviewed. Eleven had anterior instability, and one had a posterior dislocation. The average age of the patients was 62.7 years. Symptoms began soon after initial injury. All patients with anterior instability had ruptured the subscapularis and anterior capsule from the lesser tuberosity, whereas the posterior dislocator had torn the infraspinatus and upper teres minor with the posterior capsule from the greater tuberosity. No patient had a Bankart lesion. Stability was restored in all cases by reattaching the ruptured tendons and capsule to the tuberosities. Follow-up was from 2 to 13 years. One patient required a reoperation. All patients now have a stable shoulder. Recurrent instability of the shoulder after age 40 can be caused by rotator cuff and capsular rupture from the tuberosities without additional significant injury to the ligamentolabral complex. In such cases, repairing the torn structures is sufficient to restore stability.