Hostname: page-component-76fb5796d-9pm4c Total loading time: 0 Render date: 2024-04-29T12:31:18.170Z Has data issue: false hasContentIssue false
  • English
  • Français

Shoulder surgery in older patients: recommendations and techniques

Published online by Cambridge University Press:  18 October 2013

M. Valencia  and
E. Calvo
M. Valencia
Affiliation:
Upper Limb Surgery Unit, Hospital FREMAP Majadahonda, Madrid
E. Calvo*
Affiliation:
Shoulder and Elbow Reconstructive Surgery Unit, Institute of Medical Research – Fundación Jimenez Diaz, Universidad Autónoma, Madrid, Spain
*
Address for correspondence: Professor Emilio Calvo, Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopaedic Surgery and Traumatology, Director, Institute of Medical Research – Fundación Jimenez Diaz, Universidad Autónoma University, Madrid, Spain. Email: ecalvo@fjd.es
Get access Rights & Permissions [Opens in a new window]

Summary

Shoulder disorders are very common in the older population. These can be traumatic injuries such as proximal humerus fractures, or degenerative pathology, with rotator cuff disease being the most frequently diagnosed. Lower functional demands along with the presence of co-morbidities means that conservative management is usual. However, surgery can provide pain relief and improve functional outcomes in selected patients. A thorough pre-operative assessment should be performed to avoid surgical or post-operative complications. Osteoporosis is the major concern when undertaking bone fixation in orthopaedic implants and should be routinely ruled out and treated in order to achieve better results.

Keywords

rotator cuffosteoarthritisproximal humerus fractureimpingement
Type
Review Article
Information
Reviews in Clinical Gerontology , Volume 23 , Issue 4 , November 2013 , pp. 295 - 306
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Andrews, JR. Diagnosis and treatment of chronic painful shoulder: Review of non-surgical interventions. Arthroscopy 2005; 21: 333–47.CrossRefGoogle Scholar
2O'Reilly, D, Bernstein, RM. Shoulder pain in the elderly. BMJ 1990; 301: 503–4.CrossRefGoogle ScholarPubMed
3Chard, MD, Hazleman, BL. Shoulder disorders in the elderly (a hospital study). Ann Rheum Dis 1987; 46: 684–87.CrossRefGoogle ScholarPubMed
4Kelsey, JL, Browner, WS, Seeley, DG, Nevitt, MC, Cummings, SR. Risk factors for fractures of the distal forearm and proximal humerus. The study of osteoporotic fractures research group. Am J Epidemiol 1992; 135: 477–89.CrossRefGoogle Scholar
5Calvo, E, de Miguel, I, de la Cruz, JJ, López-Martín, N. Percutaneous fixation of displaced proximal humeral fractures: Indications based on the correlation between clinical and radiographic results. J Shoulder Elbow Surg 2007; 16: 774–81.CrossRefGoogle ScholarPubMed
6Court-Brown, CM, Garg, A, McQueen, MM. The epidemiology of proximal humeral fractures. Acta Orthop Scand 2001; 72: 365–71.CrossRefGoogle ScholarPubMed
7Neer, CS. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am 1970; 52: 1077–89.CrossRefGoogle ScholarPubMed
8Bell, JE, Leung, BC, Spratt, KFet al.Trends and variation in incidence, surgical treatment, and repeat surgery of proximal humeral fractures in the elderly. J Bone Joint Surg Am 2011; 93: 121–31.CrossRefGoogle ScholarPubMed
9Court-Brown, CM, McQueen, MM. The impacted varus (A2.2) proximal humeral fracture: Prediction of outcome and results of nonoperative treatment in 99 patients. Acta Orthop Scand 2004; 75: 736–40.CrossRefGoogle ScholarPubMed
10Hanson, B, Neidenbach, P, de Boer, P, Stengel, D. Functional outcomes after non-operative management of fractures of the proximal humerus. J Shoulder Elbow Surg 2009; 18: 612–21.CrossRefGoogle Scholar
11Court-Brown, CM, Garg, A, McQueen, MM. The translated two-part fracture of the proximal humerus. Epidemiology and outcome in the older patient. J Bone Joint Surg Br 2001; 83: 799–804.CrossRefGoogle ScholarPubMed
12Murray, IR, Amin, AK, White, TO, Robinson, CM. Proximal humeral fractures: Current concepts in classification, treatment and outcomes. J Bone Joint Surg Br 2011; 93: 1–11.CrossRefGoogle ScholarPubMed
13Foruria, AM, de Gracia, MM, Larson, DR, Munuera, L, Sanchez-Sotelo, J. The pattern of the fracture and displacement of the fragments predict the outcome in proximal humeral fractures. J Bone Joint Surg Br 2011; 93: 378–86.CrossRefGoogle ScholarPubMed
14Murray, IR, Amin, AK, White, TO, Robinson, CM. Proximal humeral fractures: Current concepts in classification, treatment and outcomes. J Bone Joint Surg Br 2011; 93: 1–11.CrossRefGoogle ScholarPubMed
15Bell, JE, Leung, BC, Spratt, KFet al.Trends and variation in incidence, surgical treatment, and repeat surgery of proximal humeral fractures in the elderly. J Bone Joint Surg Am 2011; 93: 121–31.CrossRefGoogle ScholarPubMed
16Namdari, S, Voleti, PB, Mehta, S. Evaluation of the osteoporotic proximal humeral fracture and strategies for structural augmentation during surgical treatment. J Shoulder Elbow Surg 2012; 21: 1787–95.CrossRefGoogle ScholarPubMed
17Blonna, D, Rossi, R, Fantino, G, Maiello, A, Assom, M, Castoldi, F. The impacted varus (A2.2) proximal humeral fracture in elderly patients: Is minimal fixation justified? A case control study. J Shoulder Elbow Surg 2009; 18: 545–52.CrossRefGoogle ScholarPubMed
18Olerud, P, Ahrengart, L, Ponzer, S, Saving, J, Tidermark, J. Internal fixation versus non-operative treatment of displaced 3-part proximal humeral fractures in elderly patients: A randomized controlled trial. J Shoulder Elbow Surg 2011; 20: 747–55.CrossRefGoogle Scholar
19Olerud, P, Ahrengart, L, Ponzer, S, Saving, J, Tidermark, J. Hemiarthroplasty versus non-operative treatment of displaced 4-part proximal humeral fractures in elderly patients: A randomized controlled trial. J Shoulder Elbow Surg 2011; 20: 1025–33.CrossRefGoogle Scholar
20Boileau, P, Krishnan, SG, Tinsi, L, Walch, G, Coste, JS, Molé, D. Tuberosity malposition and migration: Reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. J Shoulder Elbow Surg 2002; 11: 401–12.CrossRefGoogle ScholarPubMed
21Stanbury, SJ, Voloshin, I. Reverse shoulder arthroplasty for acute proximal humeral fractures in the geriatric patient: A review of the literature. Geriatr Orthop Surg Rehabil 2011; 2: 181–86.CrossRefGoogle Scholar
22Boyle, MJ, Youn, SM, Frampton, CM, Ball, CM. Functional outcomes of reverse shoulder arthroplasty compared with hemiarthroplasty for acute proximal humeral fractures. J Shoulder Elbow Surg 2013; 22: 32–37.CrossRefGoogle ScholarPubMed
23Levy, O, Pritsch, M, Rath, E. An operative technique for recurrent shoulder dislocations in older patients. J Shoulder Elbow Surg 1999; 8: 452–57.CrossRefGoogle ScholarPubMed
24Gumina, S, Postacchini, F. Anterior dislocation of the shoulder in elderly patients. J Bone Joint Surg Br 1997; 79: 540–43.CrossRefGoogle ScholarPubMed
25McLaughlin, HL, MacLellan, DI. Recurrent anterior dislocation of the shoulder. II. A comparative study. J Trauma 1967; 7: 191–201.CrossRefGoogle ScholarPubMed
26Gumina, S, Postacchini, F. Anterior dislocation of the shoulder in elderly patients. J Bone Joint Surg Br 1997; 79: 540–43.CrossRefGoogle ScholarPubMed
27Murthi, AM, Ramirez, MA. Shoulder dislocation in the older patient. J Am Acad Orthop Surg 2012; 20: 615–22.CrossRefGoogle ScholarPubMed
28Rapariz, JM, Martin-Martin, S, Pareja-Bezares, A, Ortega-Klein, J. Shoulder dislocation in patients older than 60 years of age. Int J Shoulder Surg 2010; 4: 88–92.CrossRefGoogle ScholarPubMed
29Shin, SJ, Yun, YH, Kim, DJ, Yoo, JD. Treatment of traumatic anterior shoulder dislocation in patients older than 60 years. Am J Sports Med 2012; 40: 822–27.CrossRefGoogle ScholarPubMed
30Levy, O, Pritsch, M, Rath, E. An operative technique for recurrent shoulder dislocations in older patients. J Shoulder Elbow Surg 1999; 8: 452–57.CrossRefGoogle ScholarPubMed
31Sonnabend, DH. Treatment of primary anterior shoulder dislocation in patients older than 40 years of age. Conservative versus operative. Clin Orthop Relat Res 1994; 304: 74–77.CrossRefGoogle Scholar
32Sperling, JW, Pring, M, Antuna, SA, Cofield, RH. Shoulder arthroplasty for locked posterior dislocation of the shoulder. J Shoulder Elbow Surg 2004; 13: 522–27.CrossRefGoogle ScholarPubMed
33Rees, JL. The pathogenesis and surgical treatment of tears of the rotator cuff. J Bone Joint Surg Br 2008; 90: 827–32.CrossRefGoogle ScholarPubMed
34Bigliani, LU, Ticker, JB, Flatow, EL, Soslowsky, LJ, Mow, VC. The relationship of acromial architecture to rotator cuff disease. Clin Sports Med 1991; 10: 823–38.CrossRefGoogle ScholarPubMed
35Chang, WK. Shoulder impingement syndrome. Phys Med Rehabil Clin N Am 2004; 15: 493–510.CrossRefGoogle ScholarPubMed
36Neer, CS. Impingement lesions. Clin Orthop Relat Res 1983; 173: 70–77.CrossRefGoogle Scholar
37Min, KS, St Pierre, P, Ryan, PM, Marchant, BG, Wilson, CJ, Arrington, ED. A double-blind randomized controlled trial comparing the effects of subacromial injection with corticosteroid versus NSAID in patients with shoulder impingement syndrome. J Shoulder Elbow Surg 2013; 22: 595–601.CrossRefGoogle ScholarPubMed
38Cummins, CA, Sasso, LM, Nicholson, D. Impingement syndrome: Temporal outcomes of non-operative treatment. J Shoulder Elbow Surg 2009; 18: 172–77.CrossRefGoogle Scholar
39Van der Sande, R, Rinkel, WD, Gebremariam, L, Hay, EM, Koes, BW, Huisstede, BM. Subacromial impingement syndrome: Effectiveness of pharmaceutical interventions-nonsteroidal anti-inflammatory drugs, corticosteroid, or other injections: A systematic review. Arch Phys Med Rehabil 2013; 94: 961–76.CrossRefGoogle ScholarPubMed
40Neer, CS. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: A preliminary report. J Bone Joint Surg Am 1972; 54: 41–50.CrossRefGoogle Scholar
41Donigan, JA, Wolf, BR. Arthroscopic subacromial decompression: Acromioplasty versus bursectomy alone – does it really matter? A systematic review. Iowa Orthop J 2011; 31: 121–26.Google ScholarPubMed
42Tempelhof, S, Rupp, S, Seil, R. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg 1999; 8: 296–99.CrossRefGoogle ScholarPubMed
43Sher, JS, Uribe, JW, Posada, A, Murphy, BJ, Zlatkin, MB. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am 1995; 77: 10–15.CrossRefGoogle ScholarPubMed
44Downie, BK, Miller, BS. Treatment of rotator cuff tears in older individuals: A systematic review. J Shoulder Elbow Surg 2012; 21: 1255–61.CrossRefGoogle ScholarPubMed
45De Carvalho, BR, Puri, A, Calder, JA. Open rotator cuff repairs in patients 70 years and older. ANZ J Surg 2012; 82: 461–65.CrossRefGoogle ScholarPubMed
46Robinson, PM, Wilson, J, Dalal, S, Parker, RA, Norburn, P, Roy, BR. Rotator cuff repair in patients over 70 years of age: Early outcomes and risk factors associated with re-tear. Bone Joint J 2013; 95–B: 199–205.CrossRefGoogle ScholarPubMed
47Lam, F, Mok, D. Open repair of massive rotator cuff tears in patients aged sixty-five years or over: Is it worthwhile? J Shoulder Elbow Surg 2004; 13: 517–21.CrossRefGoogle ScholarPubMed
48Tashjian, RZ, Hollins, AM, Kim, HMet al.Factors affecting healing rates after arthroscopic double-row rotator cuff repair. Am J Sports Med 2010; 38: 2435–42.CrossRefGoogle ScholarPubMed
49Djahangiri, A, Cozzolino, A, Zanetti, Met al.Outcome of single-tendon rotator cuff repair in patients aged older than 65 years. J Shoulder Elbow Surg 2013; 22: 45–51.CrossRefGoogle ScholarPubMed
50Neer, CS, Craig, EV, Fukuda, H. Cuff-tear arthropathy. J Bone Joint Surg Am 1983; 65: 1232–44.CrossRefGoogle ScholarPubMed
51Hsu, HC, Luo, ZP, Cofield, RH, An, KN. Influence of rotator cuff tearing on glenohumeral stability. J Shoulder Elbow Surg 1997; 6: 413–22.CrossRefGoogle ScholarPubMed
52Hamada, K, Yamanaka, K, Uchiyama, Y, Mikasa, T, Mikasa, M. A radiographic classification of massive rotator cuff tear arthritis. Clin Orthop Relat Res 2011; 469: 2452–60.CrossRefGoogle ScholarPubMed
53Nam, D, Maak, TG, Raphael, BS, Kepler, CK, Cross, MB, Warren, RF. Rotator cuff tear arthropathy: Evaluation, diagnosis, and treatment: AAOS exhibit selection. J Bone Joint Surg Am 2012; 94: e34.CrossRefGoogle ScholarPubMed
54Duff, SJ, Campbell, PT. Patient acceptance of long head of biceps brachii tenotomy. J Shoulder Elbow Surg 2012; 21: 61–65.CrossRefGoogle ScholarPubMed
55Boileau, P, Baqué, F, Valerio, L, Ahrens, P, Chuinard, C, Trojani, C. Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears. J Bone Joint Surg Am 2007; 89: 747–57.CrossRefGoogle ScholarPubMed
56Smith, CD, Guyver, P, Bunker, TD. Indications for reverse shoulder replacement: A systematic review. J Bone Joint Surg Br 2012; 94: 577–83.CrossRefGoogle ScholarPubMed
57DiGiovanni, J, Marra, G, Park, JY, Bigliani, LU. Hemiarthroplasty for glenohumeral arthritis with massive rotator cuff tears. Orthop Clin North Am 1998; 29: 477–89.CrossRefGoogle ScholarPubMed
58Goldberg, SS, Bell, JE, Kim, HJ, Bak, SF, Levine, WN, Bigliani, LU. Hemiarthroplasty for the rotator cuff-deficient shoulder. J Bone Joint Surg Am 2008; 90: 554–59.CrossRefGoogle ScholarPubMed
59Sanchez-Sotelo, J, Cofield, RH, Rowland, CM. Shoulder hemiarthroplasty for glenohumeral arthritis associated with severe rotator cuff deficiency. J Bone Joint Surg Am 2001; 83–A: 1814–22.CrossRefGoogle Scholar
60Boileau, P, Watkinson, DJ, Hatzidakis, AM, Balg, F. Grammont reverse prosthesis: Design, rationale, and biomechanics. J Shoulder Elbow Surg 2005; 14 (suppl): 147–61S.CrossRefGoogle ScholarPubMed
61Drake, GN, O'Connor, DP, Edwards, TB. Indications for reverse total shoulder arthroplasty in rotator cuff disease. Clin Orthop Relat Res 2010; 468: 1526–33.CrossRefGoogle ScholarPubMed
62Young, SW, Zhu, M, Walker, CG, Poon, PC. Comparison of functional outcomes of reverse shoulder arthroplasty with those of hemiarthroplasty in the treatment of cuff-tear arthropathy: A matched-pair analysis. J Bone Joint Surg Am 2013; 95: 910–15.CrossRefGoogle ScholarPubMed
63Guery, J, Favard, L, Sirveaux, F, Oudet, D, Mole, D, Walch, G. Reverse total shoulder arthroplasty. Survivorship analysis of eighty replacements followed for five to ten years. J Bone Joint Surg Am 2006; 88: 1742–47.CrossRefGoogle ScholarPubMed
64Shubin Stein, BE, Ahmad, CS, Pfaff, CH, Bigliani, LU, Levine, WN. A comparison of magnetic resonance imaging findings of the acromioclavicular joint in symptomatic versus asymptomatic patients. J Shoulder Elbow Surg 2006; 15: 56–59.CrossRefGoogle ScholarPubMed
65Levine, WN, Soong, M, Ahmad, CS, Blaine, TA, Bigliani, LU. Arthroscopic distal clavicle resection: A comparison of bursal and direct approaches. Arthroscopy 2006; 22: 516–20.CrossRefGoogle ScholarPubMed
66Vecchio, PC, Kavanagh, RT, Hazleman, BL, King, RH. Community survey of shoulder disorders in the elderly to assess the natural history and effects of treatment. Ann Rheum Dis 1995; 54: 152–54.CrossRefGoogle ScholarPubMed
67Walch, G, Badet, R, Boulahia, A, Khoury, A. Morphologic study of the glenoid in primary glenohumeral osteoarthritis. J Arthroplasty 1999; 14: 756–60.CrossRefGoogle ScholarPubMed
68Ricchetti, ET, Abboud, JA, Kuntz, AF, Ramsey, ML, Glaser, DL, Williams, GR. Total shoulder arthroplasty in older patients: Increased perioperative morbidity? Clin Orthop Relat Res 2011; 469: 1042–49.CrossRefGoogle ScholarPubMed
69Foruria, AM, Sperling, JW, Ankem, HK, Oh, LS, Cofield, RH. Total shoulder replacement for osteoarthritis in patients 80 years of age and older. J Bone Joint Surg Br 2010; 92: 970–74.CrossRefGoogle ScholarPubMed
70Sperling, JW, Cofield, RH, Schleck, CD, Harmsen, WS. Total shoulder arthroplasty versus hemiarthroplasty for rheumatoid arthritis of the shoulder: Results of 303 consecutive cases. J Shoulder Elbow Surg 2007; 16: 683–90.CrossRefGoogle ScholarPubMed
71Hattrup, SJ, Sanchez-Sotelo, J, Sperling, JW, Cofield, RH. Reverse shoulder replacement for patients with inflammatory arthritis. J Hand Surg Am 2012; 37: 1888–94.CrossRefGoogle ScholarPubMed
72Kryzak, TJ, Sperling, JW, Schleck, CD, Cofield, RH. Total shoulder arthroplasty in patients with Parkinson's disease. J Shoulder Elbow Surg 2009; 18: 96–99.CrossRefGoogle ScholarPubMed
73Pervaiz, K, Cabezas, A, Downes, K, Santoni, BG, Frankle, MA. Osteoporosis and shoulder osteoarthritis: Incidence, risk factors, and surgical implications. J Shoulder Elbow Surg 2013; 22: e1–8.CrossRefGoogle ScholarPubMed