Original article| Volume 22, ISSUE 3, P270-276, March 2006

Shoulder Instability and Related Rotator Cuff Tears: Arthroscopic Findings and Treatment in Patients Aged 40 to 60 Years

      Purpose: To report our experience with the arthroscopic treatment of patients aged 40 to 60 years with rotator cuff lesions, shoulder instability, or both, and to seek a relationship among capsular-labral complex lesions, cuff tears, number of dislocations, and patient age. Type of Study: Case series. Methods: From January 2000, all patients aged between 40 and 60 years undergoing an arthroscopic procedure for rotator cuff lesions, shoulder instability, or both were divided into 3 cohorts: shoulder instability (group I), complete cuff tear (group C), and instability and complete cuff tear (group IC). In May 2002 there were 50 patients per group. Arthroscopic findings were analyzed using the Pearson correlation coefficient and the χ2 test to seek correlations between the lesions. The Student t test was used to highlight significant differences between preoperative and postoperative scores. Results: There was a strong correlation between the rising number of dislocations and associated lesions of the supraspinatus and infraspinatus (P < .001); this correlation became stronger after 7 episodes of dislocation (P < .0001). There was no correlation between capsular or Bankart lesion and presence or absence of rotator cuff tears (P > .5). Two cases of recurrence of instability were recorded in group IC. Postoperatively, the Constant and Rowe scores rose significantly and consistently in all patients (P < .001). Conclusions: Rotator cuff tears and glenohumeral instability appear to be closely related. Patient age and number of dislocations do not appear to correlate with Bankart or capsular lesions, whereas posterosuperior cuff tears seem to be influenced by number of dislocations. Although data do not permit us to conclude whether repair of the sole cuff tear can achieve shoulder stability nor whether shoulder stabilization alone can resolve the instability, treatment of both lesions should be performed arthroscopically. Level of Evidence: Level IV, case series.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Reeves B.
        Arthrography of the shoulder.
        J Bone Joint Surg Br. 1966; 48: 424-435
        • Taylor D.C.
        • Arciero R.A.
        Pathologic changes associated with shoulder dislocations. Arthroscopic and physical examination findings in first-time, traumatic anterior dislocations.
        Am J Sports Med. 1997; 25: 306-311
        • Hawkins R.J.
        • Morin W.D.
        • Bonutti P.M.
        Surgical treatment of full-thickness rotator cuff tears in patients 40 years of age or younger.
        J Shoulder Elbow Surg. 1999; 8: 259-265
        • Neviaser R.J.
        • Neviaser T.J.
        • Neviaser J.S.
        Concurrent rupture of the rotator cuff and anterior dislocation of the shoulder in the older patient.
        J Bone Joint Surg Am. 1988; 70: 1308-1311
        • Neviaser R.J.
        • Neviaser T.J.
        • Neviaser J.S.
        Anterior dislocation of the shoulder and rotator cuff rupture.
        Clin Orthop. 1993; 291: 103-106
        • Sonnabend D.H.
        Treatment of primary anterior shoulder dislocation in patients older than 40 years of age. Conservative versus operative.
        Clin Orthop. 1994; 304: 74-77
        • Neviaser R.J.
        • Neviaser T.J.
        Recurrent instability of the shoulder after age 40.
        J Shoulder Elbow Surg. 1995; 4: 416-418
        • Hintermann B.
        • Gachter A.
        Theo van Rens Prize.
        Knee Surg Sports Traumatol Arthrosc. 1994; 2: 64-69
        • Wirth M.A.
        • Rockwood Jr, C.A.
        Operative treatment of irreparable rupture of the subscapularis.
        J Bone Joint Surg Am. 1997; 79: 722-731
        • Hsu H.C.
        • Luo Z.P.
        • Cofield R.H.
        • An K.N.
        Influence of rotator cuff tearing on glenohumeral stability.
        J Shoulder Elbow Surg. 1997; 6: 413-422
        • Loehr J.F.
        • Helmig P.
        • Sojbjerg J.O.
        • Jung A.
        Shoulder instability caused by rotator cuff lesions. An in vitro study.
        Clin Orthop. 1994; 304: 84-90
        • Hsu H.C.
        • Boardman III, N.D.
        • Luo Z.P.
        • An K.N.
        Tendon-defect and muscle-unloaded models for relating a rotator cuff tear to glenohumeral stability.
        J Orthop Res. 2000; 18: 952-958
        • Kumar V.P.
        Biomechanics of the shoulder.
        Ann Acad Med Singapore. 2002; 31: 590-592
        • Burkhart S.S.
        • Morgan C.D.
        • Kibler W.B.
        The disabled throwing shoulder: Spectrum of pathology. Part I: Pathoanatomy and biomechanics.
        Arthroscopy. 2003; 19: 404-420
        • Robinson C.M.
        • Kelly M.
        • Wakefield A.E.
        Redislocation of the shoulder during the first six weeks after a primary anterior dislocation.
        J Bone Joint Surg Am. 2002; 84: 1552-1559
        • Walch G.
        • Dejour H.
        • Trillat A.G.
        Recurrent anterior luxation of the shoulder occurring after the age of 40.
        Rev Chir Orthop Reparatrice Appar Mot. 1987; 73: 609-616
        • Constant C.
        • Murley A.H.
        A clinical method of functional assessment of the shoulder.
        Clin Orthop. 1987; 214: 160-164
        • Rowe C.R.
        • Patel D.
        • Southmayd W.W.
        The Bankart procedure.
        J Bone Joint Surg Am. 1978; 60: 1-16
        • Kim T.K.
        • Rauh P.B.
        • McFarland E.G.
        Partial tears of the subscapularis tendon found during arthroscopic procedures on the shoulder.
        Am J Sports Med. 2003; 31: 744-750
        • Araghi A.
        • Prasarn M.
        • St Clair S.
        • Zuckerman J.D.
        Recurrent anterior glenohumeral instability with onset after forty years of age.
        Bull Hosp Jt Dis. 2005; 62: 99-101