Saturday, September 11, 2010

Surgery Relieves Shoulder Pain, Even in Elderly

Briefly NotedRepairing rotator-cuff tears in the shoulders of elderly patients is often discouraged because of concerns about complications. However, a new study conducted at Rush University Medical Center, Chicago, IL, demonstrated that minimally invasive arthroscopic surgery can significantly improve pain and function in these patients.

Tears in the rotator cuff — a complex of four muscles that stabilize the back of the shoulder joint — often resulting from chronic degenerative changes, affect about 1 in 5 persons older than 65 years of age. The disorder causes considerable pain and loss of motion; however, surgery often is not recommended for these patients because circulation and bone quality already may be compromised and there may be other conditions that could compromise the healing process.

To better evaluate the potential success of shoulder surgery in the elderly, investigators identified 44 consecutive patients aged 70 years or older undergoing arthroscopic repair of symptomatic full-thickness tears of the rotator cuff [Verma et al. 2010]. More conservative treatment, such as pain medication and debridement to remove fragments of tissue, had previously been unhelpful in these patients. A minimum 2-year followup was performed, assessing range of motion and dynamometer strength testing, additional shoulder functional outcome scores, and pain scores on a visual analog scale. Nearly 89% (n=39) of the patients were available for followup (mean 36 months); average age was 75 years (range 70.1–89.8 years).

During the followup period pain scores declined significantly in 96% of patients, from 4.6 to 0.5 on average (p<0.0001). There were correspondingly significant improvements in functionality and muscle strength. Compared with age- and sex-matched controls without the shoulder disorders, male and female patients undergoing surgery achieved up to 97% and 89% of normal levels, respectively, and there was a low rate of any complications. It is important to note that in elderly patients pain relief rather than a return to full functionality is of primary concern; so, in that regard alone, the arthroscopic surgery approach was considered successful and age itself may not be a contraindication for the procedure. Almost all (94%) of the patients indicated they were pleased with the outcomes.

REFERENCE: Verma NN, Bhatia S, Baker CL, et al. Outcomes of Arthroscopic Rotator Cuff Repair in Patients Aged 70 Years or Older. Arthroscopy: J Arthro Rel Surg. 2010(Aug); online ahead of print [abstract here].