Injuries Associated with Anterior Dislocations.

Last updated Tuesday, February 01, 2005

Figure 6

Cuff tears

Rotator cuff tears

Rotator cuff tears may accompany anterior and inferior glenohumeral dislocations (see figure 6). The frequency of this complication increases with age: in patients over 40 years of age, the incidence exceeds 30 per cent; over age 60, it exceeds 80 per cent. (Itoi and Tabata, 1992; Pasila et al, 1978; Pettersson, 1942; Reeves, 1969; Sonnabend, 1994; Symeonides, 1972; Tijmes et al, 1979)

Rotator cuff tears may present as pain or weakness on external rotation and abduction. (Hawkins et al, 1984; Neviaser, 1988; Pettersson, 1942; Reeves, 1968a; White, 1976) Sonnabend reported a series of primary shoulder dislocations in patients older than 40 years of age. (Sonnabend, 1994) Of the 13 patients who had complaints of weakness or pain after 3 weeks, eleven had rotator cuff tears. However, the presence of a rotator cuff tear may be masked by a coexisting axillary nerve palsy. (Gonzalez and Lopez, 1991; Johnson and Bayley, 1981)

Shoulder ultrasonography, (Mack et al, 1985) arthrography, or magnetic resonance imaging is considered to evaluate the possibility of an associated cuff tear when:

1. shoulder dislocations occur in patients over 40 years of age,
2. there has been substantial initial displacement of the humeral head (such as in a subglenoid dislocation), and
3. there is persistent pain or loss of rotator cuff strength three weeks after a glenohumeral dislocation.

Toolanen found sonographic evidence of rotator cuff lesions in 24 of 63 patients over the age of 40 years at the time of anterior glenohumeral dislocation. (Toolanen et al, 1993)

Prompt operative repair of these acute cuff tears is usually indicated. Itoi and Tabata (Itoi and Tabata, 1992) reported 16 rotator cuff tears in 109 shoulders with a traumatic anterior dislocation. The cuff was surgically repaired in 11 shoulders, and the results were graded as satisfactory in 73% of cases.

Neviaser et al (Neviaser et al, 1993) reported on thirty-seven patients older than 40 years of age in whom the diagnosis of cuff rupture was initially missed after an anterior dislocation of the shoulder. The weakness from the cuff rupture was often erroneously attributed to axillary neuropathy. Eleven of these patients developed recurrent anterior instability that was due to rupture of the subscapularis and anterior capsule from the lesser tuberosity. None of these shoulders had a Bankart lesion. Repair of the capsule and subscapularis restored stability in all of the patients with recurrence.

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