An operative technique for recurrent shoulder dislocations in older patients

Levy, Ofer; Pritsch, Moshe; Rath, Ehud

« Previous Next »Journal of Shoulder and Elbow Surgery
Volume 8, Issue 5 , Pages 452-457, September 1999

An operative technique for recurrent shoulder dislocations in older patients

Ofer Levy, MD
- Reprint requests: Ofer Levy, MD, Department of Shoulder Surgery, Royal Berkshire Hospital, London Road, Reading RG1 5AN, United Kingdom.
- Shoulder Surgery Service, Orthopaedic Department, Soroka Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel.
- the Shoulder Surgery Service, Orthopaedic Department, Sheba Medical Center, Tel Hashomer, Israel.
Moshe Pritsch, MD
- Shoulder Surgery Service, Orthopaedic Department, Soroka Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel.
- the Shoulder Surgery Service, Orthopaedic Department, Sheba Medical Center, Tel Hashomer, Israel.
Ehud Rath, MD
- Shoulder Surgery Service, Orthopaedic Department, Soroka Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel.
- the Shoulder Surgery Service, Orthopaedic Department, Sheba Medical Center, Tel Hashomer, Israel.

Abstract

Recurrent anterior shoulder dislocation in the elderly is not as exceptional as it was once thought to be. That anterior shoulder dislocation in older patients is caused by a rotator cuff tear through the posterior mechanism is well accepted. However, in the subset of patients who have multiple recurrent or intractable dislocations develop, there may be combined pathologic conditions at work: large or massive rotator cuff tears together with anterior capsulolabral injuries such as a Bankart lesion or fracture of the glenoid rim. These patients have multiple recurrences because of disruption of both the anterior and the posterior stability mechanisms. We suggest a procedure that provides anterior stabilization with the capsular shift technique and that is supplemented by Bankart repair as necessary. The capsule transfer is performed superiorly and posteriorly to close the defect in the cuff. In this way a capsulodesis effect can be achieved that displaces the humeral head downward and produces active centering of the head in the course of abduction. Use of only the anterior capsule for the shift, and not the subscapularis tendon, does not compromise subscapularis function. Between 1990 and 1996, we used this technique to treat 16 patients older than 55 years of age with multiple recurrent anterior shoulder dislocation and massive rotator cuff tear. We report the results for the first 10 patients with a minimum follow-up of 2 years (range 2 to 7 years) and an average follow-up of 52 months. There were 7 excellent results, 2 good results, and 1 fair result according to the Rowe criteria. None of the patients had a recurrence of the dislocation. All the patients regained full or functional range of motion with stable shoulders, and most of them could perform activities of daily living without limitation. The average constant score was 83%. This procedure appears to be successful in treating older patients with recurrent shoulder dislocation.

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