THE NORMAL SHOULDER IN SUBJECTS AGED OVER 75 YEARS: STUDY OF 180 SHOULDERS

Abstract

Purpose: The purpose of this study was to define the normal shoulder in patients over 75 years of age and to search for correlations between shoulder function, mental status, and general health.

Material and methods: One hundred eighty subjects aged 75 years or older with no history of surgery involving the shoulder or neighbouring regions (breast, axillary area, elbow) were included in the study. We noted shoulder motion (flexibility ratio), rotator cuff force (Mayo scale) and searched for abnormal movements. The Quetelet body mass index (BMI) was also noted. Patients responded to a self-administered questionnaire, the Simple Shoulder Test, on shoulder function, and the Constant score was determined for each shoulder. Beck test was used to search for geriatric depression. A standard x-ray series and ultrasound exploration were performed if joint function was abnormal.

Results: Only 44% of the shoulders were entirely disease-free. Clinically silent lesions (cuff tears, osteoarthritis, stiffness) were identified in 56% of the subjects but had no impact on daily life activities. The dominant shoulder presented 56.4% of the cuff tears; 13.9% of the subjects had bilateral degenerative joint disease and 23.3% bilateral stiffness. Associated conditions were numerous: cardiovascular (33%), pulmonary (28%), gastrointestinal (25.6%), diabetes (12.2%), neoplasia (10.6%). 18.3 % of the patients had signs of depression and 14.4% were treated for depression. Shoulder motion and force varied with the BMI and nutritional status. Thin patients (BMI < 20) had more rotator cuff tears. Heavy patients (BMI > 29.9) had more osteoarthritis and stiffness. 76.8% of the subjects were satisfied with their shoulder function. Demand for care and examination was greater in depressive patients.

Discussion: In very old subjects, shoulder function is compatible with the demands of daily life activities. Shoulder function is correlated with general health status, the BMI, and the mental status. Shoulders should be prudently evaluated in the elderly because function, even when altered, is often compatible with moderate stiffness, osteoarthritis, and cuff tears which do not necessarily require treatment.