Understanding shoulder pseudoparalysis. Part II: Treatment.

Area of Science:

• Orthopedic Surgery
• Shoulder Reconstruction
• Rotator Cuff Repair

Background:

• Pseudoparalytic shoulder management is complex, requiring extensive surgical experience.
• Treatment decisions are multifactorial, influenced by clinical presentation, tissue integrity, and patient-specific factors.

Purpose of the Study:

• To outline the decision-making process for pseudoparalytic shoulder treatment.
• To review current management strategies, including non-operative care, tendon transfers, and shoulder arthroplasty.

Main Methods:

• Evaluation of clinical findings to define pseudoparesis and pseudoparalysis.
• Assessment of rotator cuff tear patterns and tissue quality for repairability.
• Review of surgical options based on functional deficits (elevation, rotation).

Main Results:

• Non-operative treatment is considered for high-risk patients, but evidence requires strengthening.
• Tendon transfers (e.g., latissimus dorsi) address irreparable rotator cuff loss affecting rotation.
• Partial repairs and superior capsular reconstruction are options for elevation deficits.

Conclusions:

• Treatment selection for pseudoparalytic shoulders is tailored to individual patient factors and specific functional impairments.
• Reverse shoulder arthroplasty (RSA), alone or combined with tendon transfer, is an option for complex cases with combined deficits or failed previous interventions.