Management of Anterior Glenohumeral Dislocations in Elderly Patients

The pathoanatomy of anterior glenohumeral dislocations in elderly patients is different from those in younger patients in that rotator cuff tears, large glenoid fractures, and peripheral nerve injury are more common. In addition, decision making is made more complex by the wide spectrum of preexisting degenerative pathology, functional demands, and social considerations, such as arthritis, chronic rotator cuff tears, and upper extremity demand for ambulation. Many patients with a first-time dislocation can be treated conservatively with a brief period of immobilization followed by physical rehabilitation. Rotator cuff repair is advisable for most active patients with symptomatic, acute tears. Capsulolabral repairs can be considered for similarly active patients with recurrent instability. Fixation of large glenoid fractures should be considered for patients with displaced fragments >25% of the glenoid width and/or demonstrating humeral subluxation through the fragment if there is adequate bone quality and healing potential. Reverse shoulder arthroplasty plays a large role in managing recurrent instability in patients with limited potential for soft-tissue or bone healing, inability to comply with soft-tissue repair postoperative protocols, and preexisting degenerative changes.