Elderly Women Right Up There with Young Male
Athletes in a Risk of Shoulder Dislocation
New reports has more evidence of the serious consequences of
falls by senior citizens – women in particular
March 1, 2010 - The shoulder joint is the most
mobile joint in the body and consequently one of the most commonly
dislocated joints. It is no surprise to that most dislocations occur
during sports and young males are at the highest risk. What is
surprising is that another group that rates highly on the risk scale for
a dislocate shoulder are elderly women.
A new report indicates that rate of shoulder
location occurrences has more than doubled in the U.S. to an overall
incidence rate of 23.9 shoulder dislocations per 100,000 person years
(the product of the number of years times the number of members of a
population who have been affected by a certain condition).
Dislocations most frequently
resulted from a fall (58.8 percent), of which 47.7 percent of these
falls occurring at home and 33.6 percent occurring at recreation or
sports sites.
Falls are the leading cause of fatal and nonfatal
injuries in people 65 and older in the United States.
Falls can happen anytime and anyplace to people of
any age, but most falls by people 65 years of age and older occur in the
home during everyday activities. Senior citizens have been known to fall
walking across a cluttered living room floor, in a slippery bathroom or
while standing on a stool reaching into a cupboard.
The number of falls and the severity of injury
resulting from falls increases as people get older.
In older women, higher dislocation rates were seen
among those aged 80 to 90 years old, according to the article published
in the March 2010 issue of
The Journal of Bone and Joint Surgery (JBJS). This increase was
mostly due to
falls at home.
“We were not too surprised to find the high number
of young males dislocating their shoulders during athletic activity,”
commented Brett Owens, MD, study co-author, orthopaedic surgeon at
Keller Army Hospital in West Point, New York and Associate Professor at
the Uniformed Services University of the Health Sciences.
“However, the rate of shoulder dislocations among
elderly women was higher than we had previously assumed.”
Should dislocations, though increasing, are still
occurring at lower rates than other common musculoskeletal injuries seen
in emergency rooms, such as injuries to the
lower back,
knee and
foot. The most common serious injuries for senior citizens are head
injuries, wrist fractures, spine fractures, and hip fractures.
“Shoulder instability is one of the most common
reasons young athletes see orthopaedic surgeons,” explained Brett Owens.
“However little has been reported about the
incidence of this injury.”
Dr. Owens and his colleagues studied 8,940 shoulder
dislocations in patients presenting to 100 hospital emergency rooms
across the United States from 2002 to 2006. The purpose of the study was
to identify the specific groups of individuals at risk, to help direct
prevention efforts.
Of all dislocations, the study found:
● 71.8 percent were in men;
● 46.8 percent were in patients between 15-29 years;
● 48.3 percent occurred during sports or recreation; and
● 37 percent of all sports-related injuries were
football or basketball related.
The shoulder joint can dislocate forward, backward
or downward. The most common shoulder dislocation happens when the
shoulder slips forward (anterior instability). The arm bone is moved
forward and down and out of its joint.
Dislocated shoulder symptoms include:
● pain;
● swelling;
● numbness;
● weakness; and
● bruising.
Often the dislocation will tear ligaments or
tendons in the shoulder or even damage nearby nerves. To treat the
dislocation, the doctor must manipulate the arm bone (the humerus) and
replace it in the shoulder socket. This stops the severe pain and allows
for the injured tissues to heal.
“Individuals who dislocate their shoulders should
see an orthopaedic surgeon. While not all patients require surgery, an
orthopaedist can best counsel patients on the treatment options and
expected outcomes,” said Dr. Owens.
Falls are a Serious Problem for America’s Senior
Citizens
Cost of Falls Among Elderly
The cost of falls among older people is enormous
because of the high death toll, disabling conditions and recovery in
hospitals and rehabilitation institutions. The United States spends more
than $20 billion annually for the treatment of injuries to older people
after falls.
The majority of the cost is for hip fracture care, which
averaged $37,000 per patient in 2006. The Center for Disease Control and
Prevention (CDC) estimates that by the year 2020, the annual direct and
indirect cost of fall injuries is expected to reach $54.9 billion (in
2007 dollars).
Facts About Falls by Older People
Thirty percent of people over the age of 65 will
fall each year. In 2006, about 1.8 million people 65 and older were
treated in emergency departments for nonfatal injuries from falls, and
more than 433,000 of these patients were hospitalized.
Ninety percent of the 380,000 hip fractures treated
annually in the United States occur as a result of a fall.
In 2006, there were more than 380,000 hip
fractures, or about 1,050 hip fractures a day.
Approximately 25% of hip fracture patients will
make a full recovery; 40% will require nursing home admission; 50% will
be dependent upon a cane or a walker; and 20% will die in one year.
The National Osteoporosis Foundation reports that a
total of 15,802 persons aged 65 years and older died as a result of
injuries from falls in 2005.
There is a Pattern of Falls Among the Elderly
There is a pattern to falls among the elderly. The
fear of falling, then the injury, followed by hospitalization, decreased
independence and mobility, and often relocation to a nursing or
residential institution.
Falls can be a major life-changing event that robs
the elderly of their independence.
What Seniors Should Do If They Fall
● Don't panic. Assess the situation and determine if you are hurt.
● Slide or crawl along the floor to the nearest couch or chair and
try to get up.
● If you can't get up, call for help.
● If you are alone, crawl slowly to the
telephone and call 911 or relatives.
Personal Risk Fctors
Personal risk factors account for approximately 75%
of the risk of falls and are related to acquired disabilities,
age-related changes and current diseases.
● Age. The rate of hip fractures increases after age 50, doubling
every five to six years.
● Activity. Lack of weight-bearing exercise leads to decreased bone
strength.
● Gender. Reduced levels of estrogen after female menopause can
result in osteoporosis. Women have two to three times as many hip
fractures as men and a 20% chance of a hip fracture during their
lifetime.
● Habits. Smoking and/or excessive alcohol intake decreases bone
strength.
● Heredity. Caucasians and Asians with small, slender body structures
are at risk; so are people who have a family history of fractures later
in life.
● Nutrition. Low calcium dietary intake, reduced
calcium absorption and inadequate vitamin D are factors in osteoporosis.
Editor’s Notes: The authors report they did
not receive any outside funding or grants in support of their research
for or preparation of this work. Neither they nor a member of their
immediate families received payments or other benefits or a commitment
or agreement to provide such benefits from a commercial entity.
The opinions presented by Dr Owens are his own and
not the official positions of the US Army, Department of Defense, or US
government.
Links to More Archived Reports on
Senior Citizens and Risk of Falls
One-point decrease on social activity scale was
equivalent to being approximately five years older at the start of the
study - risk of death, disability jump
March 1, 2010 - The shoulder joint is the most
mobile joint in the body and consequently one of the most commonly
dislocated joints. It is no surprise to that most dislocations occur
during sports and young males are at the highest risk. What is
surprising is that another group that rates highly on the risk scale for
a dislocate shoulder are elderly women.
