1Department of Orthopedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
2Department of Orthopedic Surgery, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
*Corresponding author: Jong-Ho Kim,
Department of Orthopedic Surgery, Yeouido St. Mary’s Hospital, The
Catholic University of Korea, Yeongdeungpo-gu 63ro 10, Seoul 07345, Korea,
E-mail: katris@naver.com
• Received: November 16, 2024 • Revised: December 24, 2024 • Accepted: January 7, 2025
This is an Open-Access article distributed under the terms of the
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This review classifies and summarizes the major shoulder diseases affecting older
adults, focusing on rotator cuff disease, frozen shoulder, osteoarthritis, and
shoulder instability. It explores each condition's pathophysiology, risk
factors, clinical presentation, diagnostic approaches, and treatment strategies
to guide clinicians in optimizing patient outcomes and enhancing quality of
life. Age-related degenerative changes, comorbidities, and distinct etiological
factors contribute to the presentation of shoulder disorders in older adults.
Rotator cuff disease ranges from tendinopathy to full-thickness tears and is
influenced by genetic predispositions, inflammatory cytokines, and muscle
quality. Frozen shoulder results from fibroproliferative changes in the capsule,
leading to significant pain and restricted motion. Osteoarthritis involves
cartilage degeneration and bony remodeling, often necessitating surgical
interventions such as arthroplasty. Shoulder instability, though less frequent,
is complicated by associated injuries like rotator cuff tears and fractures,
requiring tailored management strategies. Advances in imaging techniques,
biologic treatments, and surgical procedures, particularly arthroscopic and
arthroplasty options, have improved diagnostic accuracy and therapeutic
outcomes. A thorough classification of shoulder diseases in older adult patients
highlights the complexity of managing these conditions. Effective treatment
requires individualized approaches that integrate conservative measures with
emerging biologic or surgical therapies. Future research should focus on
targeted interventions, standardized diagnostic criteria, and multidisciplinary
collaboration to minimize disability, optimize function, and improve overall
quality of life in this growing patient population. Multimodal strategies,
including patient education, structured rehabilitation, and psychosocial
support, further enhance long-term adherence and outcomes. Ongoing vigilance for
comorbidities, such as osteoporosis or metabolic disorders, is necessary for
comprehensive care.
The shoulder joint is crucial for performing daily activities and maintaining
independence, especially among older adults. Its extensive range of motion
renders it vulnerable to injuries and degenerative diseases, which are more
common as people age [1]. Aging leads to
structural changes in the musculoskeletal system, including decreased bone
density, reduced tendon elasticity, and diminished joint lubrication [2]. These factors predispose older adults to
conditions such as rotator cuff tears, osteoarthritis, frozen shoulder, and
instability [1,3,4].
Objectives
This review aims to provide a detailed classification of shoulder diseases,
focusing on their pathophysiology, risk factors, clinical presentation,
diagnostic approaches, and treatment strategies. By tailoring management to the
specific needs of older adult patients, clinicians can improve outcomes and
enhance the quality of life for this vulnerable population.
Ethics statement
As this study is a literature review, it did not require approval from the
institutional review board or individual consent.
Rotator cuff diseases
Rotator cuff diseases are a common condition affecting the upper extremity, with
manifestations ranging from mild tendinopathy to full-thickness tears accompanied by
arthritis [2–4]. These injuries compromise the functionality of the shoulder,
leading to pain, restricted mobility, and weakness [5]. The rotator cuff consists of four muscles—the supraspinatus,
infraspinatus, subscapularis, and teres minor—which stabilize the shoulder
and enable movement. Rotator cuff tears often occur due to a combination of
traumatic events and degenerative changes, particularly affecting the supraspinatus
tendon, which is especially susceptible due to its hypovascular nature.
The epidemiology of rotator cuff tears shows that their prevalence increases with
age. Research indicates a strong correlation between aging and the development of
these tears, with about 62% of individuals over the age of 80 experiencing such
injuries [6]. Genetics also contribute to the
risk, as familial predispositions and genetic markers associated with inflammation
and tissue remodeling can heighten susceptibility. Additional risk factors are
diabetes, obesity, smoking, and repetitive physical activity [7].
The pathophysiology of rotator cuff tears involves a complex interplay among tendon
degeneration, inflammation, and muscle quality [7]. Tendon injuries typically start with microtrauma, which leads to
tendinopathy and may eventually progress to partial or full-thickness tears.
Inflammatory cytokines, including IL-6 and IL-1β, significantly contribute to
tendon degeneration. Additionally, muscle atrophy and fatty infiltration are known
to adversely affect surgical outcomes and impede tendon healing [8]. Advanced imaging techniques, such as MRI and
ultrasound, are crucial for diagnosing these conditions by enabling the assessment
of tear size, muscle quality, and tendon retraction.
Diagnosis involves a combination of clinical evaluation and imaging. Patients
typically present with shoulder pain, especially at night, difficulty performing
overhead activities, and weakness [9,10]. Physical examination tests, including the
Neer, Jobe, and Hawkins-Kennedy tests, are used to assess muscle strength and
functionality. Imaging techniques such as X-rays, MRI, and ultrasound help confirm
the diagnosis, assess the size of the tear, and evaluate the quality of the muscle.
However, standardizing the diagnostic approach is challenging due to the variability
in tear progression and symptoms [10].
Management strategies for rotator cuff tears are customized based on the
patient's symptoms, the size of the tear, and their activity levels [9]. Non-operative treatments, which include
physical therapy, pharmacotherapy, and corticosteroid injections, prove effective
for the majority of patients. Physical therapy aims to restore shoulder mobility,
muscle strength, and scapular stability [11].
Pharmacological treatments, such as NSAIDs and corticosteroids, offer short-term
relief from pain. Additionally, emerging therapies like platelet-rich plasma and
mesenchymal stem cell injections are currently under investigation for their
potential to promote healing, although their long-term effectiveness is still
unclear [12].
Surgical interventions are typically reserved for cases where non-operative
treatments are unsuccessful or for patients with acute, traumatic tears [5,9].
Arthroscopic rotator cuff repair is considered the standard surgical method,
offering a less invasive option with improved recovery times [13]. However, the rates of retear are still high, especially in
patients with poor muscle quality or large tears. Advanced techniques such as
double-row suture bridge repair and biologic augmentation with mesenchymal stem
cells or platelet-rich plasma are employed to enhance tendon-to-bone healing and
reduce the likelihood of retears [14]. In
situations involving irreparable tears, alternative strategies like tendon transfer
or reverse shoulder arthroplasty might be considered, particularly for older
patients [15–17].
The natural history of rotator cuff tears is unpredictable. While many tears remain
asymptomatic, others may progress, resulting in increased pain and functional
limitations. Factors such as age, tear size, and comorbidities influence the
progression of these tears. It is important to note that symptomatic degenerative
tears rarely heal on their own and necessitate careful monitoring and management to
prevent further complications [18].
Quality of life for individuals with rotator cuff tears can be significantly
impacted. Pain, reduced mobility, and sleep disturbances contribute to decreased
physical and emotional well-being [19].
Patient education and timely interventions are crucial for improving outcomes and
restoring functionality. Future research aims to identify novel therapeutic targets,
optimize treatment protocols, and enhance tendon-to-bone healing processes. Rotator
cuff tears represent a complex and multifaceted condition, characterized by a broad
spectrum of presentations and management options. While non-operative treatments
suffice for most patients, advanced surgical techniques and emerging therapies offer
hope for improved outcomes in severe cases. Continued research and personalized care
approaches are essential for addressing the challenges associated with this
condition.
Frozen shoulder
Frozen shoulder, or adhesive capsulitis, is a debilitating condition characterized by
pain and a progressive loss of shoulder mobility [20]. It is typically divided into primary and secondary forms; primary
cases arise without a clear cause, while secondary cases are linked to trauma,
surgery, or underlying medical conditions [21]. The condition generally evolves through three overlapping phases: the
painful "freezing" stage, the stiff "frozen" stage, and
the "thawing" stage, where gradual improvement occurs [22]. However, many patients continue to
experience symptoms beyond these stages. Frozen shoulder is characterized by
fibroproliferative tissue fibrosis, in which fibroblasts and myofibroblasts
overproduce collagen. This leads to inflammation, neo-angiogenesis, and capsule
contracture, ultimately resulting in restricted shoulder movement and pain [21,22].
The condition most commonly affects individuals in their 50s and has a lifetime
prevalence of 2%–5%. Risk factors include diabetes, cardiovascular disease,
thyroid disorders, autoimmune diseases, obesity, smoking, and low levels of physical
activity. Notably, up to 60% of individuals with diabetes may develop frozen
shoulder, and the presence of comorbidities such as Dupuytren's disease also
increases the risk [20–24].
The pathophysiology of frozen shoulder involves inflammation, vascular and neural
changes, and excessive extracellular matrix remodeling [20–22]. Chronic
unresolved inflammation is a central feature, with immune cells such as T cells and
macrophages playing significant roles. Pro-inflammatory cytokines, including IL-1,
IL-6, and transforming growth factor-β, are crucial in promoting fibrosis and
inflammation. Fibroblast activation is also key, as these cells produce abnormal
amounts of collagen and matrix proteins, which contribute to increased stiffness
[25]. Additionally, neural changes, such
as heightened nerve sensitivity and an increased expression of pain-related
receptors, contribute to the severe pain experienced with this condition, especially
at night. Furthermore, advanced glycation end products, which are often elevated in
individuals with diabetes, exacerbate fibrosis and inflammation by altering tissue
remodeling processes [26].
The diagnosis of frozen shoulder primarily relies on clinical assessment, which
includes evaluating pain and the restriction of both active and passive shoulder
movement. Imaging modalities like X-rays, MRI, and ultrasound are useful for
distinguishing this condition from other pathologies, although routine imaging is
not always necessary. The lack of standardized diagnostic criteria presents
challenges, and differentiating frozen shoulder from other conditions, such as
rotator cuff tendinopathy or joint arthrosis, can be difficult in the early stages
[21].
Management of frozen shoulder presents a significant challenge, as the condition
often resolves spontaneously within 1–2 years. However, symptoms persist in a
considerable number of patients [27,28]. Non-operative treatments, which are the
initial approach to management, include patient education, physiotherapy,
pharmacotherapy, and corticosteroid injections. Patient education is aimed at
explaining the natural history of the condition, reducing anxiety, and setting
realistic expectations for recovery. Physiotherapy involves mobility exercises that
are customized according to the stage of the disease and the severity of pain,
incorporating techniques such as stretching and joint mobilization. Nonetheless, the
long-term benefits of physiotherapy remain uncertain, and excessive intensity during
the inflammatory stage may exacerbate symptoms.
Pharmacological options for treatment include NSAIDs, acetaminophen, and
corticosteroids. Intra-articular corticosteroid injections have been shown to
effectively reduce pain and inflammation in the early stages, although their
benefits tend to be short-lived [29].
Alternative interventions, such as injections of sodium hyaluronate, suprascapular
nerve blocks, and hydrodilatation (capsular distension with saline or
corticosteroids), are promising but still require more research. Hydrodilatation, in
particular, is becoming increasingly popular due to its potential to enhance range
of motion and alleviate pain. Additionally, emerging therapies like collagenase
injections and botulinum toxin are under investigation, with preliminary evidence
supporting their effectiveness in certain scenarios [30,31].
For patients who do not respond to non-operative treatments, surgical options are
considered. Manipulation under anesthesia involves forcibly stretching the joint to
break adhesions. In contrast, arthroscopic capsular release (ACR) provides direct
visualization and surgical removal of fibrotic tissue. Both methods enhance range of
motion and alleviate pain; however, ACR is more invasive and costly. The decision
between surgical and non-surgical options is influenced by the severity of the
disease, patient preference, and access to healthcare. Research, including the UK
FROST trial, indicates that all approaches significantly improve patient outcomes,
with ACR showing the most consistent results in refractory cases [32].
Quality of life is significantly impacted by frozen shoulders, which cause severe
pain, functional limitations, and sleep disturbances. This condition often leads to
anxiety and depression, further exacerbating the overall burden. Patients frequently
express frustration over delayed diagnoses and unclear management pathways [33]. These issues underscore the importance of
patient-centered care, timely diagnosis, and clear communication regarding treatment
options.
Advancements in research are revealing the intricate mechanisms behind frozen
shoulder, which include the roles of inflammation, fibrosis, angiogenesis, and
neural sensitization. Translational studies are investigating new therapeutic
targets, such as anti-inflammatory agents, gene silencing of fibrotic pathways, and
alarmin inhibitors [34,35]. Although these emerging therapies are promising,
challenges persist in standardizing clinical trials and managing the diverse
characteristics of the patient population. Future efforts will focus on developing
personalized treatment strategies and incorporating basic science findings into
clinical practice.
In conclusion, frozen shoulder is a complex condition that significantly impacts both
clinical and psychological aspects of health. Although it is self-limiting, many
patients experience prolonged symptoms that disrupt daily activities and overall
well-being. Current management strategies primarily aim to control symptoms and
enhance functionality. However, there is an urgent need for more effective,
evidence-based interventions. Enhancing our knowledge of the disease's
pathophysiology and risk factors is crucial for developing targeted therapies and
achieving better outcomes for those affected by this debilitating condition.
Osteoarthritis
Shoulder osteoarthritis is a prevalent chronic condition that significantly impacts
quality of life by causing pain and disability [36]. It commonly affects older adults, particularly women and
individuals who are obese. The shoulder joint, known for its complex structure and
extensive range of motion, ranks as the third most frequent site of musculoskeletal
pain, following the lower back and knee. This condition targets the synovial joint,
resulting in cartilage degeneration, abnormal bone remodeling, osteophyte formation,
and inflammation. The development of osteoarthritis is influenced by both mechanical
wear and inflammatory processes, which are driven by cytokines, degradative enzymes,
and immune system pathways [37].
The primary contributors to shoulder osteoarthritis include aging, genetic
predisposition, and obesity, along with trauma, rotator cuff tears, and joint
instability [36,38]. Traumatic injuries, whether acute or repetitive, can lead
to posttraumatic arthritis, which accounts for approximately 12% of osteoarthritis
cases. Chronic rotator cuff tears often result in a specific pattern of
osteoarthritis known as cuff tear arthropathy, characterized by upward migration of
the humeral head, which alters the joint structure. Additionally, glenoid dysplasia
and chronic glenohumeral instability predispose individuals to shoulder
osteoarthritis [36,38].
The diagnosis of shoulder osteoarthritis typically involves a clinical evaluation
complemented by imaging studies. Radiographs serve as the primary imaging modality
and are frequently augmented by MRI, CT, or ultrasound to provide more detailed
assessments. Classic signs observed in radiographs include joint space narrowing,
subchondral sclerosis, cyst formation, and osteophyte growth. Advanced imaging plays
a crucial role in evaluating associated pathologies such as rotator cuff or glenoid
issues, and in assessing the thickness of cartilage and the quality of bone [39].
Management of shoulder osteoarthritis depends on the severity of symptoms and the
extent of joint damage. Non-surgical treatments include physical therapy,
pharmacological interventions like NSAIDs, and corticosteroid injections to
alleviate pain and inflammation [39]. In more
severe cases, surgical interventions are considered, particularly shoulder
arthroplasty. There are three main types of shoulder arthroplasty: partial shoulder
replacement, anatomic total shoulder arthroplasty, and reverse total shoulder
arthroplasty [40,41].
Partial shoulder replacement, which includes humeral head resurfacing arthroplasty
and humeral hemiarthroplasty, targets pathology on the humeral side, preserves bone
stock, and maintains native anatomy [42].
Anatomic total shoulder arthroplasty treats both the humeral and glenoid surfaces
and depends on a functional rotator cuff for successful outcomes. Reverse total
shoulder arthroplasty, specifically designed for patients with rotator cuff tears,
alters the normal ball-and-socket joint configuration to restore function via
deltoid muscle tension [40,41].
Each type of arthroplasty comes with its own set of indications and postoperative
challenges. Common complications include component loosening, glenohumeral
instability, periprosthetic fractures, rotator cuff tears, infection, and nerve
injury. The most frequent complication is component loosening, particularly of the
glenoid component, often due to wear and instability. Glenohumeral instability
typically presents as anterior or superior displacement, generally resulting from
rotator cuff failure or incorrect positioning of the prosthetic components.
Periprosthetic fractures may occur during surgery due to the techniques used, or
postoperatively as a result of trauma. Although infections are relatively rare, they
are serious complications that frequently necessitate revision surgery [40,41].
Reverse total shoulder arthroplasty is associated with unique complications,
including anterosuperior instability resulting from unopposed deltoid contraction
and scapular notching due to mechanical impingement. Other concerns include
fractures of the acromial or scapular spine and mechanical failure of the prosthetic
components, such as dislodgment of the glenosphere [40].
Preoperative imaging is essential in planning for arthroplasty, as it allows for the
assessment of rotator cuff integrity and glenoid morphology, which are key factors
in determining the appropriate surgical procedure. An intact rotator cuff is
essential for successful anatomic total shoulder arthroplasty, whereas reverse total
shoulder arthroplasty is more appropriate for patients with rotator cuff
deficiencies. Advanced imaging techniques are used to evaluate glenoid morphology
and bone stock, employing classifications such as the modified Walch criteria to
facilitate surgical planning. Challenges such as posterior glenoid wear or
retroversion are addressed through techniques like asymmetric glenoid reaming, bone
grafting, and the use of augmented components [41].
In summary, shoulder osteoarthritis significantly contributes to pain and disability,
especially among the elderly. The complexity of the condition, its variable
progression, and its profound impact on quality of life underscore the need for
customized management strategies. Ongoing advancements in imaging, surgical methods,
and prosthetic designs have enhanced outcomes for patients undergoing shoulder
arthroplasty. Radiologists are crucial in diagnosing osteoarthritis, assessing
preoperative findings, and detecting postoperative complications, thereby playing a
key role in patient care.
Shoulder instability
Shoulder instability in older patients is characterized by a lower recurrence rate
than in younger populations, yet it is frequently accompanied by a higher incidence
of complications such as rotator cuff tears, fractures, and neurologic injuries
[43]. In older adults, acute dislocations
typically occur due to traumatic events that compromise the shoulder's
stabilizing structures, including the anterior capsule, glenohumeral ligaments, and
labrum. Additionally, age-related degeneration and comorbidities such as
osteoporosis and rotator cuff degeneration present unique challenges in the
management of shoulder instability in this age group [43,44].
The incidence of shoulder instability increases with age, peaking in women over 80
years, with traumatic anterior dislocations being the most common form [44]. Although older adults have lower
recurrence rates compared to younger individuals, they frequently suffer from
associated injuries. Up to 86% of patients older than 40 years experience rotator
cuff tears following an anterior dislocation. These tears can range from small
lesions to massive tears involving the posterosuperior or anterosuperior rotator
cuff. Additionally, fractures such as Hill-Sachs lesions, greater tuberosity
fractures, and glenoid fractures occur more frequently in this age group due to
osteoporotic bone. Neurologic injuries, including axillary nerve or brachial plexus
lesions, are also more common and severe in older adults, with recovery being less
predictable than in younger patients [43,44].
The mechanisms underlying shoulder instability vary with age. In younger individuals,
anterior dislocations are frequently associated with Bankart lesions, which involve
the labrum and capsuloligamentous structures. In contrast, older patients more
commonly experience capsular ruptures and rotator cuff tears, indicative of
age-related tissue weakening. Although less common, posterior instability is often
related to rotator cuff deficiency or low-energy trauma, and chronic dislocations
can present significant diagnostic challenges.
The management of shoulder instability in older patients is tailored to the specific
injury pattern and the patient's overall health. For acute anterior
dislocations, the initial treatment typically involves a gentle closed reduction,
followed by imaging studies such as X-rays or CT scans to evaluate any associated
injuries [45]. Conservative management, which
includes sling immobilization, physical therapy, and gradual strengthening
exercises, is suitable for first-time dislocations or stable reductions that do not
involve significant tears or fractures. However, surgical intervention may be
required in cases of recurrent instability, large rotator cuff tears, or significant
bone deficiencies [45,46].
Surgical options vary depending on the specific pathology. Rotator cuff repairs are
recommended for large or massive tears, especially when they are associated with
functional deficits or nerve injuries. Bankart repairs, which are often performed
alongside rotator cuff repairs, are indicated in cases of recurrent instability when
there is no significant bone loss [47,48]. Severe deficiencies in the glenoid or
humerus may require reconstructive procedures, such as glenoid augmentation with
grafts or reverse total shoulder arthroplasty. The latter is particularly
advantageous for patients with irreparable rotator cuff tears, chronic dislocations,
or complex fractures [46,49].
The complications of shoulder instability in older patients include stiffness,
persistent pain, and functional limitations [44]. It is crucial to address all components of the injury, such as
rotator cuff pathology, osseous defects, and ligamentous damage, to optimize
outcomes. However, maintaining a balance between achieving stability and preserving
motion continues to be a challenge. In cases of chronic anterior dislocations,
extensive releases, including pectoralis major release, may be necessary to achieve
reduction. However, these procedures carry significant risks, such as vascular
injury or residual instability [43].
Posterior shoulder instability, while less common, requires careful evaluation due to
its frequent association with undiagnosed chronic dislocations [50]. Radiographic assessments in orthogonal
planes and advanced imaging like CT are critical for identifying reverse Hill-Sachs
lesions or posterior glenoid fractures. Treatment involves reduction techniques
tailored to the chronicity and severity of the dislocation, with arthroplasty often
being the preferred option for severe cases with substantial bone or soft tissue
loss [50].
In summary, shoulder instability in older patients poses unique diagnostic and
management challenges due to age-related degenerative changes, associated injuries,
and diminished tissue healing capacity. Although this condition has a lower
recurrence rate in older individuals compared to younger ones, it is complicated by
the presence of associated injuries such as rotator cuff tears, fractures, and
neurologic injuries. Tailored treatment strategies that combine conservative
management with advanced surgical interventions when necessary are essential for
enhancing outcomes and restoring function in this demographic. Continued research
and advancements in surgical methods and prosthetic designs are promising for
overcoming the challenges associated with shoulder instability in older adults.
Table 1 shows a comparative overview of four
major shoulder diseases in older adults.
Table 1.
Comparative clinical characteristics of four major shoulder diseases in
older adults
Condition
Pathophysiology
Risk factors
Clinical presentation
Diagnostic approaches
Treatment strategies
Rotator cuff disease
Tendon degeneration, inflammation, and
microtrauma leading to tendinopathy or tears. Involves cytokines
(IL-6, IL-1β), muscle atrophy, and fatty infiltration.
Age (higher prevalence in those >80
years), genetics, diabetes, obesity, smoking, repetitive physical
activity
Pain (often nocturnal), limited mobility,
weakness, difficulty with overhead activities
Clinical exam (Neer, Jobe,
Hawkins–Kennedy tests), X-rays, MRI, ultrasound to assess
tear size, tendon retraction, and muscle quality
Pain, stiffness, crepitus, functional
limitations, often worsened by activity
X-rays (joint space narrowing,
osteophytes), MRI or CT (assess rotator cuff, glenoid wear, bone
quality), ultrasound (soft tissue evaluation)
Conservative (physical therapy, NSAIDs,
corticosteroid injections) or surgical (arthroplasty:
partial/hemi-arthroplasty, anatomic total shoulder, reverse total
shoulder arthroplasty) based on cuff integrity and severity of
damage
Shoulder instability
Disruption of stabilizing structures
(capsule, ligaments, labrum) due to traumatic events or degenerative
changes. Often complicated by rotator cuff tears, fractures, or
neurologic injuries in older patients.
Advancing age, osteoporosis, rotator cuff
degeneration, comorbidities (e.g., diabetes), history of
dislocation
Acute or chronic dislocation, pain,
inability to move the arm, associated rotator cuff or bony
injuries
Radiographs or CT for fracture assessment,
MRI for soft tissue lesions, clinical exam to assess stability
Closed reduction, immobilization, and
rehabilitation if stable; surgical repair (rotator cuff, Bankart,
arthroplasty) if there is recurrent instability, large tears, or
osseous deficiencies
Conclusion
Shoulder diseases in older adults, including rotator cuff disease, frozen shoulder,
osteoarthritis, and instability, pose significant challenges due to age-related
degeneration and comorbidities. Effective management necessitates an accurate
diagnosis, individualized treatment, and an appropriate balance between conservative
and surgical approaches. Advances in surgical techniques, biologic therapies, and
imaging have improved outcomes, but careful patient selection and multidisciplinary
care remain critical. Future research should focus on optimizing therapeutic
strategies and addressing the broader impacts of these conditions on quality of
life. A patient-centered, evidence-based approach is essential to improving outcomes
and improving the well-being of this vulnerable population.
Authors' contributions
Project administration: Kim JH
Conceptualization: Kim JH
Methodology & data curation: Lee HJ, Kim JH
Funding acquisition: not applicable
Writing – original draft: Lee HJ
Writing – review & editing: Lee HJ, Kim JH
Conflict of interest
No potential conflict of interest relevant to this article was reported.
Funding
Not applicable.
Data availability
Not applicable.
Acknowledgments
Not applicable.
Supplementary materials
Not applicable.
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Classification of shoulder diseases in older adult patients: a
narrative review
Classification of shoulder diseases in older adult patients: a
narrative review
Comparative clinical characteristics of four major shoulder diseases in
older adults
Condition
Pathophysiology
Risk factors
Clinical presentation
Diagnostic approaches
Treatment strategies
Rotator cuff disease
Tendon degeneration, inflammation, and
microtrauma leading to tendinopathy or tears. Involves cytokines
(IL-6, IL-1β), muscle atrophy, and fatty infiltration.
Age (higher prevalence in those >80
years), genetics, diabetes, obesity, smoking, repetitive physical
activity
Pain (often nocturnal), limited mobility,
weakness, difficulty with overhead activities
Clinical exam (Neer, Jobe,
Hawkins–Kennedy tests), X-rays, MRI, ultrasound to assess
tear size, tendon retraction, and muscle quality
Pain, stiffness, crepitus, functional
limitations, often worsened by activity
X-rays (joint space narrowing,
osteophytes), MRI or CT (assess rotator cuff, glenoid wear, bone
quality), ultrasound (soft tissue evaluation)
Conservative (physical therapy, NSAIDs,
corticosteroid injections) or surgical (arthroplasty:
partial/hemi-arthroplasty, anatomic total shoulder, reverse total
shoulder arthroplasty) based on cuff integrity and severity of
damage
Shoulder instability
Disruption of stabilizing structures
(capsule, ligaments, labrum) due to traumatic events or degenerative
changes. Often complicated by rotator cuff tears, fractures, or
neurologic injuries in older patients.
Advancing age, osteoporosis, rotator cuff
degeneration, comorbidities (e.g., diabetes), history of
dislocation
Acute or chronic dislocation, pain,
inability to move the arm, associated rotator cuff or bony
injuries
Radiographs or CT for fracture assessment,
MRI for soft tissue lesions, clinical exam to assess stability
Closed reduction, immobilization, and
rehabilitation if stable; surgical repair (rotator cuff, Bankart,
arthroplasty) if there is recurrent instability, large tears, or
osseous deficiencies
Table 1.
Comparative clinical characteristics of four major shoulder diseases in
older adults
