Shoulder Dislocation in Elderly Patients

Diagnostic Approach

The American College of Radiology recommends standard radiographs including AP views in internal and external rotation plus an axillary or scapula-Y view as the initial diagnostic step 2
The American College of Radiology suggests MR arthrography as the gold standard for evaluating shoulder instability and associated rotator cuff pathology, with an appropriateness rating of 9/9 2
MRI without contrast may be preferred in acute dislocation settings, with an appropriateness rating of 7/9 when MR arthrography is unavailable 1, 2
Post-reduction radiographs are necessary to confirm successful reduction and evaluate for fractures, as recommended by Praxis Medical Insights 3

Older patients are more likely to have rotator cuff tears in association with shoulder dislocation compared to younger patients, according to the Journal of the American College of Radiology 1

Overlooking associated rotator cuff tears in older patients can impact outcomes and lead to secondary osteoarthritis and persistent symptoms, as noted by Praxis Medical Insights 3
Vascular assessment is critical, especially with proximal humeral fractures, as axillary artery injury can occur, as recommended by Praxis Medical Insights 3