Merck Manual

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Spotlight on Aging: Dislocations

Spotlight on Aging: Dislocations

People who are over 65 are more likely to dislocate a joint, partly because they are more likely to fall Falls in Older People Most falls occur when older people with one or more physical conditions that impair mobility or balance encounter an environmental hazard. Although many people have no symptoms before a fall... read more —a common cause of dislocations. Older people are more likely to fall for the following reasons:

Other injuries tend to accompany a dislocation more often in older people. For example, a shoulder dislocation is more likely to cause a torn rotator cuff Rotator Cuff Injury/Subacromial Bursitis The muscles that help hold the upper arm in the shoulder joint (the rotator cuff muscles) can get pinched (shoulder impingement syndrome), become inflamed (tendinitis), or can tear partially... read more in older people than in younger people.

In older people, recovery is often more complicated and slower than it is in younger people because

  • Older people typically have less overall strength, less flexibility, and poorer balance than younger people. Thus, compensating for the limitations caused by a dislocation is harder, and returning to daily activities is more difficult.

  • When older people are inactive or immobilized (by casts or splints), they lose muscle tissue more quickly than younger adults, Thus, immobilization can lead to muscle weakness. Sometimes muscles become permanently shorter, and scar tissue forms in tissues around the joint such as ligaments and tendons. This condition (called joint contractures) limits movement of the joint.

  • Older people are more likely to have other disorders (such as arthritis or poor circulation), which can interfere with recovery or slow healing.

Even minor injuries can greatly interfere with older people’s ability to do normal daily activities, such as eating, dressing, bathing, and even walking, especially if they used a walker before the injury.

Immobilization: Being immobilized (for example, when bed rest is necessary) is a particular problem in older people.

In older people, being immobilized is more likely to cause

Pressure sores develop when blood flow to an area is cut off or greatly reduced. In older people, blood flow to a limb may already be reduced. When the weight of an injured limb rests on a cast, blood flow is reduced even more, and pressure sores may form. If bed rest is required, pressure sores can develop on areas of skin that touch the bed. These areas should be diligently inspected for any sign that the skin is breaking down.

Because immobilization is more likely to cause problems in older people, treatment of dislocations and other musculoskeletal injuries focuses on helping older people return to daily activities as quickly as possible.