Comparison of surgical and conservative treatment of shoulder instability after primary dislocation in patients over 45 years old
Introduction Shoulder dislocation is one of the most common shoulder injuries and occurs in all age groups. Methods for diagnosing and treatment of the middle and older age groups patients with acute injury currently remain open. Surgical treatment is usually applied only in cases of chronic instability. However, conservative treatment in cases with a missed rotator cuff tear leads to a dysfunction of the shoulder joint and can lead to the development of chronic pain and recurrent shoulder instability. Therefore, it is necessary to develop an algorithm for diagnosing the rotator cuff tear and to find the most optimal methods for its surgical correction. The purpose of the study was to compare the results of conservative and surgical treatment in patients of the middle and older age groups after traumatic dislocation of the shoulder, accompanied by rotator cuff tear. Materials and methods The study is based on a prospective analysis of examination and treatment of 114 patients with shoulder dislocation aged 18 to 89 years. Among all patients with rotator cuff tear, 19 patients were selected for conservative treatment and 24 patients for surgical refixation of the rotator cuff tendons. Results The result of treatment was assessed 12 months after the surgical operation or the injury using ULCA shoulder score, DASH and ASES. It was found the scores of patients who underwent surgery for rotator cuff tear were significantly better than in the patients treated conservatively. Conclusion Therefore, all patients of middle and older age groups with dislocation of the shoulder should be examined for the presence of rotator cuff tear. In case the rotator cuff is torn, surgical treatment is preferred over conservative treatment.