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Updated: Jul 9, 2026
Modified Long Head of Biceps Tendon Rerouting and Fixation as Partial Capsular Reconstruction for Massive Irreparable Rotator Cuff Tears
Published on: March 6, 2026
Incidence and risk factors of pseudoparesis in massive rotator cuff tears: a systematic review and meta-analysis
Hongwei Zhan1, Yao Li2, Yue Wang1
1Department of Sports Medicine, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Background:
Among patients with massive rotator cuff tears (MRCT), some present with minimal pain but an inability to actively elevate the shoulder beyond 90°, a condition that frequently impairs quality of life. Comprehensive analyses of the risk factors for pseudoparesis in MRCT are lacking, and the role of certain factors remains controversial. This systematic review and meta-analysis aimed to quantify the incidence of pseudoparesis in MRCT and to identify its associated risk factors.
Methods:
This systematic review was conducted in strict accordance with the PRISMA guidelines. A comprehensive search of PubMed, Web of Science, Embase, and Cochrane Library databases was performed from their inception to July 20, 2025. We included all original human studies that reported the incidence of pseudoparesis and/or its associated factors in patients with MRCT. For continuous variables, pooled effect sizes were calculated as mean differences (MD) with 95% confidence intervals (CI), while for dichotomous variables, odds ratios (OR) with 95% CI were used.
Results:
Twenty-four studies met the eligibility criteria. The pooled incidence of pseudoparesis among patients with MRCT was 24.6% (95% CI, 20.7% to 28.8%). Meta-analysis revealed that several factors were significantly associated with an increased risk of pseudoparesis: older age (MD 4.38, 95% CI 2.37 to 6.38; P < 0.0001), female sex (odds ratio [OR] 1.74, 95% CI 1.12 to 2.71; P = 0.0140), fatty infiltration of the subscapularis (SSC) (MD 0.72, 95% CI, 0.49-0.95; P < 0.0001), greater critical shoulder angle (CSA) (MD 1.68, 95% CI, 0.67-2.69; P = 0.0011), reduced acromiohumeral distance (AHD) (MD - 2.71, 95% CI, - 3.34 to - 2.07; P < 0.0001), and greater global tear extension on MRI (MD 52.74, 95% CI, 44.63-60.86; P < 0.0001). Qualitative synthesis from three studies additionally identified SSC tear as a significant risk factor.
Conclusion:
The pooled analysis revealed a pseudoparesis incidence of 24.6% in patients with MRCT. Significant risk factors associated with pseudoparesis included older age, fatty infiltration and tears of the SSC, greater CSA, reduced AHD, and larger global tear extension. Systematic review registration This systematic review was registered in PROSPERO (CRD420251110594).
