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Dislocated shoulder, then what?

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Magnus Wennerlund
Posts: 27
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This is a common patient at an orthopedic clinic. 71 year old lady with no history of shoulder pain from her right side. 10 days prior to the visit with me she fell and dislocated her shoulder. It was put back into place at the emergency department. X-ray images taken before and after repositioning. So is everything all right now?
Well, in this age group the risk of an additional rotator cuff tear is very high. When I saw her she had very poor function in both abduction and flexion. As suspected, a full thickness tear of the supraspinatus was found. So what’s next?
We know that many of these patients can get a good function, especially in a case like this when subscapularis, infraspinatus and teres minor is still intact. On the other hand this patient is fit for her age, the tendon is not that far retracted and the quality of the torn muscle/tendon looks ok. To make matters even more complicated she has a similar injury on her left shoulder on degenerative basis. On that side (left) she has no big problems. Should we wait and see how much of her function she can regain with a rehab program? If we do so the window for surgery will be closed ?
To suture or not to suture? That can be a very tricky question to answer, ultimately for the shoulder surgeon and the patient. No matter what will be decided in this case it puts the finger on the importance of early image evaluation after shoulder dislocations, especially on everyone over 40 years of age!