{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T23:27:53Z","timestamp":1788305273815,"version":"build-2803163510"},"reference-count":50,"publisher":"The Ewha Medical Journal, Ewha Womans University College of Medicine","issue":"1","license":[{"start":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T00:00:00Z","timestamp":1738281600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":["www.e-emj.org"],"crossmark-restriction":true},"short-container-title":["Ewha Med J"],"abstract":"<jats:p>\n                This review classifies and summarizes the major shoulder diseases affecting older\n                    adults, focusing on rotator cuff disease, frozen shoulder, osteoarthritis, and\n                    shoulder instability. It explores each condition's pathophysiology, risk\n                    factors, clinical presentation, diagnostic approaches, and treatment strategies\n                    to guide clinicians in optimizing patient outcomes and enhancing quality of\n                    life. Age-related degenerative changes, comorbidities, and distinct etiological\n                    factors contribute to the presentation of shoulder disorders in older adults.\n                    Rotator cuff disease ranges from tendinopathy to full-thickness tears and is\n                    influenced by genetic predispositions, inflammatory cytokines, and muscle\n                    quality. Frozen shoulder results from fibroproliferative changes in the capsule,\n                    leading to significant pain and restricted motion. Osteoarthritis involves\n                    cartilage degeneration and bony remodeling, often necessitating surgical\n                    interventions such as arthroplasty. Shoulder instability, though less frequent,\n                    is complicated by associated injuries like rotator cuff tears and fractures,\n                    requiring tailored management strategies. Advances in imaging techniques,\n                    biologic treatments, and surgical procedures, particularly arthroscopic and\n                    arthroplasty options, have improved diagnostic accuracy and therapeutic\n                    outcomes. A thorough classification of shoulder diseases in older adult patients\n                    highlights the complexity of managing these conditions. Effective treatment\n                    requires individualized approaches that integrate conservative measures with\n                    emerging biologic or surgical therapies. Future research should focus on\n                    targeted interventions, standardized diagnostic criteria, and multidisciplinary\n                    collaboration to minimize disability, optimize function, and improve overall\n                    quality of life in this growing patient population. Multimodal strategies,\n                    including patient education, structured rehabilitation, and psychosocial\n                    support, further enhance long-term adherence and outcomes. Ongoing vigilance for\n                    comorbidities, such as osteoporosis or metabolic disorders, is necessary for\n                    comprehensive care.\n            <\/jats:p>","DOI":"10.12771\/emj.2025.e5","type":"journal-article","created":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T09:20:41Z","timestamp":1740388841000},"update-policy":"https:\/\/doi.org\/10.12771\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Classification of shoulder diseases in older adult patients: a\n                    narrative review"],"prefix":"10.12771","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7708-4754","authenticated-orcid":false,"given":"Hyo-Jin","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5475-1529","authenticated-orcid":false,"given":"Jong-Ho","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4998","published-online":{"date-parts":[[2025,1,31]]},"reference":[{"issue":"6","key":"key2.0250224102027e+13_B1","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1002\/art.1780340619","article-title":"Shoulder disorders in the elderly: a community\n                        survey","volume":"34","author":"Chard","year":"1991","journal-title":"Arthritis Rheum"},{"issue":"3","key":"key2.0250224102027e+13_B2","doi-asserted-by":"crossref","first-page":"345","DOI":"10.5397\/cise.2024.00283","article-title":"Factors associated with patient satisfaction after arthroscopic\n                        rotator cuff repair: do they differ by age?","volume":"27","author":"Kim","year":"2024","journal-title":"Clin Shoulder Elb"},{"issue":"4","key":"key2.0250224102027e+13_B3","doi-asserted-by":"crossref","first-page":"437","DOI":"10.5397\/cise.2024.00521","article-title":"The impact of supraspinatus tear on subscapularis muscle atrophy\n                        and fatty infiltration","volume":"27","author":"Kim","year":"2024","journal-title":"Clin Shoulder Elb"},{"issue":"3","key":"key2.0250224102027e+13_B4","doi-asserted-by":"crossref","first-page":"323","DOI":"10.5397\/cise.2023.00430","article-title":"Rotator cuff degeneration and healing after rotator cuff\n                        repair","volume":"26","author":"Gumina","year":"2023","journal-title":"Clin Shoulder Elb"},{"issue":"3","key":"key2.0250224102027e+13_B5","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1097\/JSA.0000000000000207","article-title":"Rotator cuff disease: treatment options and\n                        considerations","volume":"26","author":"Dang","year":"2018","journal-title":"Sports Med Arthrosc Rev"},{"issue":"3","key":"key2.0250224102027e+13_B6","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1177\/2151458515583895","article-title":"Rotator cuff tears in the elderly patients","volume":"6","author":"Geary","year":"2015","journal-title":"Geriatr Orthop Surg Rehabil"},{"issue":"1","key":"key2.0250224102027e+13_B7","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.jse.2009.04.006","article-title":"Prevalence and risk factors of a rotator cuff tear in the general\n                        population","volume":"19","author":"Yamamoto","year":"2010","journal-title":"J Shoulder Elb Surg"},{"issue":"4","key":"key2.0250224102027e+13_B8","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1136\/jisakos-2016-000074","article-title":"Rotator cuff pathology: state of the art","volume":"2","author":"Zumstein","year":"2017","journal-title":"J ISAKOS"},{"issue":"1","key":"key2.0250224102027e+13_B9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.csm.2022.08.001","article-title":"Surgery and rotator cuff disease: a review of the natural\n                        history, indications, and outcomes of nonoperative and operative treatment\n                        of rotator cuff tears","volume":"42","author":"Moran","year":"2023","journal-title":"Clin Sports Med"},{"issue":"2","key":"key2.0250224102027e+13_B10","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1007\/s00776-012-0345-2","article-title":"Rotator cuff tear: physical examination and conservative\n                        treatment","volume":"18","author":"Itoi","year":"2013","journal-title":"J Orthop Sci"},{"issue":"2","key":"key2.0250224102027e+13_B11","doi-asserted-by":"crossref","first-page":"86","DOI":"10.5397\/cise.2020.00031","article-title":"Clinical results of conservative management in patients with\n                        full-thickness rotator cuff tear: a meta-analysis","volume":"23","author":"Karasuyama","year":"2020","journal-title":"Clin Shoulder Elb"},{"issue":"1","key":"key2.0250224102027e+13_B12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5397\/cise.2018.21.1.1","article-title":"Will platelet rich plasma open new era for treatment of rotator\n                        cuff tear?","volume":"21","author":"Choi","year":"2018","journal-title":"Clin Shoulder Elb"},{"issue":"2","key":"key2.0250224102027e+13_B13","doi-asserted-by":"crossref","first-page":"263","DOI":"10.4055\/cios21135","article-title":"Clinical and anatomical outcomes of arthroscopic repair of large\n                        rotator cuff tears with allograft patch augmentation: a prospective,\n                        single-blinded, randomized controlled trial with a long-term\n                        follow-up","volume":"14","author":"Lee","year":"2022","journal-title":"Clin Orthop Surg"},{"issue":"7","key":"key2.0250224102027e+13_B14","doi-asserted-by":"crossref","first-page":"23259671211016847","DOI":"10.1177\/23259671211016847","article-title":"Application of platelet-rich plasma in arthroscopic rotator cuff\n                        repair: a systematic review and meta-analysis","volume":"9","author":"Xu","year":"2021","journal-title":"Orthop J Sports Med"},{"issue":"3","key":"key2.0250224102027e+13_B15","doi-asserted-by":"crossref","first-page":"327","DOI":"10.5397\/cise.2024.00248","article-title":"Comparison of clinical outcomes of anterior combined latissimus\n                        dorsi and teres major tendon transfer for anterior superior irreparable\n                        rotator cuff tear between young and elderly patients","volume":"27","author":"Baek","year":"2024","journal-title":"Clin Shoulder Elb"},{"issue":"4","key":"key2.0250224102027e+13_B16","doi-asserted-by":"crossref","first-page":"464","DOI":"10.5397\/cise.2024.00304","article-title":"Outcomes of lateralized reverse total shoulder arthroplasty\n                        versus latissimus dorsi transfer for external rotation deficit: a systematic\n                        review and meta-analysis","volume":"27","author":"Hones","year":"2024","journal-title":"Clin Shoulder Elb"},{"issue":"6","key":"key2.0250224102027e+13_B17","doi-asserted-by":"crossref","first-page":"1384","DOI":"10.1016\/j.jse.2020.08.023","article-title":"Preliminary outcomes of arthroscopic biceps rerouting for the\n                        treatment of large to massive rotator cuff tears","volume":"30","author":"Kim","year":"2021","journal-title":"J Shoulder Elbow Surg"},{"issue":"7","key":"key2.0250224102027e+13_B18","doi-asserted-by":"crossref","first-page":"2073","DOI":"10.1007\/s00167-016-4388-3","article-title":"Tear progression of symptomatic full-thickness and\n                        partial-thickness rotator cuff tears as measured by repeated\n                        MRI","volume":"25","author":"Kim","year":"2017","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"10","key":"key2.0250224102027e+13_B19","doi-asserted-by":"crossref","first-page":"2134","DOI":"10.1016\/j.jse.2022.03.007","article-title":"Rotator cuff tendinopathy: magnitude of incapability is\n                        associated with greater symptoms of depression rather than pathology\n                        severity","volume":"31","author":"Rohrback","year":"2022","journal-title":"J Shoulder Elbow Surg"},{"issue":"3","key":"key2.0250224102027e+13_B20","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1093\/mr\/road087","article-title":"Frozen shoulder. An overview of pathology and biology with hopes\n                        to novel drug therapies","volume":"34","author":"Tamai","year":"2023","journal-title":"Mod Rheumatol"},{"issue":"4","key":"key2.0250224102027e+13_B21","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1177\/1758573215601779","article-title":"Frozen shoulder","volume":"7","author":"Rangan","year":"2015","journal-title":"Shoulder Elb"},{"issue":"1","key":"key2.0250224102027e+13_B22","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1186\/s12891-016-1190-9","article-title":"The pathophysiology associated with primary (idiopathic) frozen\n                        shoulder: a systematic review","volume":"17","author":"Ryan","year":"2016","journal-title":"BMC Musculoskelet Disord"},{"issue":"6","key":"key2.0250224102027e+13_B23","doi-asserted-by":"crossref","first-page":"869","DOI":"10.4093\/dmj.2022.0275","article-title":"The risk of shoulder adhesive capsulitis in individuals with\n                        prediabetes and type 2 diabetes mellitus: a longitudinal nationwide\n                        population-based study","volume":"47","author":"Kim","year":"2023","journal-title":"Diabetes Metab J"},{"issue":"1","key":"key2.0250224102027e+13_B24","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.jse.2024.03.063","article-title":"Higher body mass index increases the risk of shoulder adhesive\n                        capsulitis in young adults: a nationwide cohort study","volume":"34","author":"Kim","year":"2025","journal-title":"J Shoulder Elbow Surg"},{"issue":"1","key":"key2.0250224102027e+13_B25","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1186\/s12891-019-2709-7","article-title":"Metabolic profiling of serum and tissue from the rotator interval\n                        and anterior capsule in shoulder stiffness: a preliminary\n                        study","volume":"20","author":"Lee","year":"2019","journal-title":"BMC Musculoskelet Disord"},{"issue":"10","key":"key2.0250224102027e+13_B26","doi-asserted-by":"crossref","first-page":"23259671211032543","DOI":"10.1177\/23259671211032543","article-title":"Comparison of gene expression of inflammation- and\n                        fibrosis-related factors between the anterior and posterior capsule in\n                        patients with rotator cuff tear and shoulder stiffness","volume":"9","author":"Kim","year":"2021","journal-title":"Orthop J Sports Med"},{"issue":"9","key":"key2.0250224102027e+13_B27","doi-asserted-by":"crossref","first-page":"536","DOI":"10.5435\/00124635-201109000-00004","article-title":"Adhesive capsulitis of the shoulder","volume":"19","author":"Neviaser","year":"2011","journal-title":"J Am Acad Orthop Surg"},{"issue":"12","key":"key2.0250224102027e+13_B28","doi-asserted-by":"crossref","first-page":"e544","DOI":"10.5435\/JAAOS-D-17-00606","article-title":"Treatment of adhesive capsulitis of the shoulder","volume":"27","author":"Redler","year":"2019","journal-title":"J Am Acad Orthop Surg"},{"issue":"12","key":"key2.0250224102027e+13_B29","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2020.29581","article-title":"Comparison of treatments for frozen shoulder: a systematic review\n                        and meta-analysis","volume":"3","author":"Challoumas","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"8","key":"key2.0250224102027e+13_B30","doi-asserted-by":"crossref","first-page":"2553","DOI":"10.1007\/s00167-020-06390-x","article-title":"Hydrodilatation with corticosteroids is the most effective\n                        conservative management for frozen shoulder","volume":"29","author":"L\u00e4dermann","year":"2021","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"11","key":"key2.0250224102027e+13_B31","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1302\/2058-5241.2.160061","article-title":"Indications for hydrodilatation for frozen\n                        shoulder","volume":"2","author":"Rymaruk","year":"2017","journal-title":"EFORT Open Rev"},{"issue":"10256","key":"key2.0250224102027e+13_B32","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1016\/S0140-6736(20)31965-6","article-title":"Management of adults with primary frozen shoulder in secondary\n                        care (UK FROST): a multicentre, pragmatic, three-arm, superiority randomised\n                        clinical trial","volume":"396","author":"Rangan","year":"2020","journal-title":"Lancet"},{"issue":"3","key":"key2.0250224102027e+13_B33","doi-asserted-by":"crossref","first-page":"E1219","DOI":"10.1016\/j.asmr.2022.04.001","article-title":"Depression and anxiety are associated with worse subjective and\n                        functional baseline scores in patients with frozen shoulder contracture\n                        syndrome: a systematic review","volume":"4","author":"Brindisino","year":"2022","journal-title":"Arthrosc Sports Med Rehabil"},{"key":"key2.0250224102027e+13_B34","doi-asserted-by":"crossref","first-page":"28","DOI":"10.3310\/nihropenres.13275.1","article-title":"Anti-TNF (adalimumab) injection for the treatment of adults with\n                        frozen shoulder during the pain predominant stage protocol for a\n                        multi-centre, randomised, double blind, parallel group, feasibility\n                        trial","volume":"2","author":"Hopewell","year":"2022","journal-title":"NIHR Open Res"},{"issue":"5","key":"key2.0250224102027e+13_B35","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2023-078273","article-title":"Anti-TNF (adalimumab) injection for the treatment of\n                        pain-predominant early-stage frozen shoulder: the anti-freaze-feasibility\n                        randomised controlled trial","volume":"14","author":"Hopewell","year":"2024","journal-title":"BMJ Open"},{"issue":"4","key":"key2.0250224102027e+13_B36","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1016\/j.rcl.2022.03.003","article-title":"Shoulder osteoarthritis","volume":"60","author":"Stanborough","year":"2022","journal-title":"Radiol Clin North Am"},{"issue":"6","key":"key2.0250224102027e+13_B37","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/j.jisako.2023.10.012","article-title":"Shoulder osteoarthritis across the lifespan","volume":"8","author":"Voss","year":"2023","journal-title":"J ISAKOS"},{"issue":"5","key":"key2.0250224102027e+13_B38","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.jisako.2023.06.002","article-title":"Non-operative management of shoulder osteoarthritis: current\n                        concepts","volume":"8","author":"Yamamoto","year":"2023","journal-title":"J ISAKOS"},{"issue":"3","key":"key2.0250224102027e+13_B39","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jht.2022.06.008","article-title":"Shoulder structure and function: the impact of osteoarthritis and\n                        rehabilitation strategies","volume":"35","author":"Vocelle","year":"2022","journal-title":"J Hand Ther"},{"issue":"12","key":"key2.0250224102027e+13_B40","doi-asserted-by":"crossref","first-page":"2895","DOI":"10.1016\/j.jse.2021.06.010","article-title":"Glenohumeral osteoarthritis with intact rotator cuff treated with\n                        reverse shoulder arthroplasty: a systematic review","volume":"30","author":"Heifner","year":"2021","journal-title":"J Shoulder Elbow Surg"},{"issue":"7s","key":"key2.0250224102027e+13_B41","doi-asserted-by":"crossref","first-page":"S131","DOI":"10.1016\/j.jse.2020.11.030","article-title":"Anatomic total shoulder arthroplasty for primary glenohumeral\n                        osteoarthritis is associated with excellent outcomes and low revision rates\n                        in the elderly","volume":"30","author":"Jensen","year":"2021","journal-title":"J Shoulder Elbow Surg"},{"issue":"6","key":"key2.0250224102027e+13_B42","doi-asserted-by":"crossref","first-page":"2925","DOI":"10.1007\/s00590-024-04010-9","article-title":"Long-term survival of resurfacing humeral\n                        hemiarthroplasty","volume":"34","author":"Miettinen","year":"2024","journal-title":"Eur J Orthop Surg Traumatol"},{"issue":"8","key":"key2.0250224102027e+13_B43","doi-asserted-by":"crossref","first-page":"2448","DOI":"10.1007\/s11999-013-3290-2","article-title":"Rotator cuff tear and glenohumeral instability: a systematic\n                        review","volume":"472","author":"Gombera","year":"2014","journal-title":"Clin Orthop Relat Res"},{"issue":"3","key":"key2.0250224102027e+13_B44","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.ocl.2014.04.002","article-title":"Shoulder instability in older patients","volume":"45","author":"Paxton","year":"2014","journal-title":"Orthop Clin North Am"},{"issue":"2","key":"key2.0250224102027e+13_B45","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/j.arthro.2021.07.022","article-title":"Anterior shoulder instability part I: diagnosis, nonoperative\n                        management, and Bankart repair: an international consensus\n                        statement","volume":"38","author":"Hurley","year":"2022","journal-title":"Arthroscopy J Arthrosc Relat Surg"},{"issue":"11","key":"key2.0250224102027e+13_B46","doi-asserted-by":"crossref","first-page":"2791","DOI":"10.1016\/j.arthro.2020.09.024","article-title":"Anterior shoulder instability management: indications,\n                        techniques, and outcomes","volume":"36","author":"Arner","year":"2020","journal-title":"Arthroscopy"},{"issue":"11","key":"key2.0250224102027e+13_B47","first-page":"2081","article-title":"Recurrent instability after arthroscopic Bankart reconstruction:\n                        a systematic review of surgical technical factors","volume":"33","author":"Brown","year":"2017","journal-title":"Arthroscopy"},{"issue":"14","key":"key2.0250224102027e+13_B48","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1136\/bjsports-2014-094342","article-title":"Risk factors which predispose first-time traumatic anterior\n                        shoulder dislocations to recurrent instability in adults: a systematic\n                        review and meta-analysis","volume":"49","author":"Olds","year":"2015","journal-title":"Br J Sports Med"},{"issue":"17","key":"key2.0250224102027e+13_B49","doi-asserted-by":"crossref","first-page":"587","DOI":"10.5435\/JAAOS-D-16-00408","article-title":"Instability in reverse total shoulder\n                        arthroplasty","volume":"26","author":"Chae","year":"2018","journal-title":"J Am Acad Orthop Surg"},{"issue":"7","key":"key2.0250224102027e+13_B50","doi-asserted-by":"crossref","first-page":"1805","DOI":"10.1177\/0363546515577622","article-title":"Posterior instability of the shoulder: a systematic review and\n                        meta-analysis of clinical outcomes","volume":"43","author":"DeLong","year":"2015","journal-title":"Am J Sports Med"}],"container-title":["The Ewha Medical Journal"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.e-emj.org\/download\/download_pdf?doi=10.12771\/emj.2025.e5","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/www.e-emj.org\/download\/download_pdf?doi=10.12771\/emj.2025.e5","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,6]],"date-time":"2025-03-06T02:09:46Z","timestamp":1741226986000},"score":1,"resource":{"primary":{"URL":"https:\/\/e-emj.org\/journal\/view.php?doi=10.12771\/emj.2025.e5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,31]]},"references-count":50,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,31]]}},"alternative-id":["10.12771\/emj.2025.e5"],"URL":"https:\/\/doi.org\/10.12771\/emj.2025.e5","relation":{},"ISSN":["2234-2591"],"issn-type":[{"value":"2234-2591","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,31]]},"assertion":[{"value":"2024-11-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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