Review Question - QID 218203

Rotator cuff tears are one of the most common injuries that occur after shoulder dislocations in patients aged >40 and more commonly require surgical repair than the labrum or associated structures.

Rotator cuff tears are most common in the elderly population but can also occur in middle-aged patients after a traumatic glenohumeral joint dislocation. After the initial dislocation and reduction event these patients present with residual weakness, most commonly in the supraspinatus and infraspinatus distributions. The subscapularis can also be involved. Studies have demonstrated improved pain and functional outcomes with surgical repair of these traumatic rotator cuff tears. While labral and capsular pathology may also be present, these lesions do not require surgical management as frequently in this age group compared to younger patients. This highlights the importance of early identification and advanced imaging in this patient population to address these injuries expediently.

Gombera and Sekiya reviewed rotator cuff tears in the setting of glenohumeral instability. They note that patients who have a dislocation and have pain and loss of function often have a rotator cuff tear that may benefit from repair with improved pain relief and patient satisfaction. They also pointed out that restoration of normal rotator cuff function helped to improve shoulder stability.

Robinson et al. looked at injuries associated with traumatic anterior glenohumeral joint dislocations in 3,633 patients. They noted that 33.4% had a rotator cuff tear or humeral head fracture. These injuries were more common in females aged >60. They noted that careful evaluation of rotator cuff function after these injuries was important to avoid failing to address a repairable cuff.

Incorrect Answer:
Answers 2-5: The anterior labrum, anterior glenohumeral ligaments, and biceps tendon may all be injured during an anterior glenohumeral joint dislocation but in a patient >40 years old the risk for surgical repair of the rotator cuff being necessary is higher. A Hill-Sachs lesion may be present in the humeral head but does not usually need to be addressed in this population.