Pseudoparalysis: a systematic review of term definitions, treatment approaches, and outcomes of management techniques

Pseudoparalysis remains one of the most challenging conditions in shoulder surgery. Long thought of as an unsolvable problem, recent advances in surgical techniques offer potential return of overhead motion in the setting of massive irreparable rotator cuff tears. This article summarizes the available literature including existing definitions and the results of different treatment approaches regarding range of motion, outcome scores, and reversal.

In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review of the MEDLINE database, Cochrane database, Physiotherapy Evidence Database, and Google Scholar database was performed for studies that defined a preoperative shoulder group as having pseudoparalysis. A secondary search included preoperative active forward elevation less than 90°.

In 16 studies, the most consistent definition was a massive rotator cuff tear with active elevation less than 90°, but studies inconsistently included stiffness, external rotation loss, arthritic changes, neurologic status, and pain. There were 6 different techniques: nonoperative rehabilitation, rotator cuff repair, muscle transfer, hemiarthroplasty, reverse total shoulder arthroplasty, and reverse total shoulder arthroplasty with muscle transfer. Postoperatively, all approaches showed improvement.

Pseudoparalysis of the shoulder has a variable definition in the literature without consideration of degree or substratification of other confounders such as the presence of arthritis or pain. Thus the literature supports treating this condition with any variety of treatment. We propose that pseudoparalysis be more restrictively defined to allow comparisons. In addition, we propose an algorithm to serve as a treatment guideline to aid in surgical decision making for this condition.