Pseudoparalysis: Pathomechanics and clinical relevance

Abstract

Shoulder pseudoparalysis has been one of the most controversial issues in recent literature. Different opinions have been expressed for the definition of this condition without ending up in a formal consensus. We try to include the different definitions as they have been used not only in the current literature but also in the daily practice of a shoulder surgeon. Biomechanics of shoulder pseudoparalysis is very interesting since the clinical relevance of massive rotator cuff tears could vary significantly, from patients with almost a full range of active motion to disabled patients with no active motion of the shoulder. Therefore, this chapter helps clarifying this controversy by describing the biomechanical function of the rotator cuff as the current literature describes. Taking into account the controversy on the definition and the complexity of the pseudoparalysis' biomechanics, it is easily understood that why so many different treatment options have been supported. Conservative treatment, partial or complete rotator cuff repair, reverse total shoulder arthroplasty, tendon transfer, and superior capsular reconstruction with allograft or fascia lata autograft have been proposed as options for the management of patients with pseudoparalysis and there are many factors that influence the surgeons' selection.