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Understanding shoulder pseudoparalysis. Part II: Treatment. | LitMetric

Understanding shoulder pseudoparalysis. Part II: Treatment.

EFORT Open Rev

Deaprtment of Orthopaedic Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.

Published: March 2022

AI Article Synopsis

  • Decision-making for treating pseudoparalytic shoulders is complex and requires a high level of expertise, factoring in clinical findings, tissue quality, and specific patient and surgeon criteria.
  • Non-operative treatments are usually the first choice for higher-risk patients, but more evidence is needed to understand their true value.
  • Treatment options for irreparable conditions include tendon transfers and partial cuff repairs, while the best approach for combined losses of elevation and external rotation remains unclear, with reverse shoulder arthroplasty being a possible solution.

Article Abstract

Decision-making for the treatment of pseudoparalytic shoulders is complex and a high level of experience in shoulder surgery and outcome evaluation is required. Management and results depend on clinical findings, tear and tissue quality, patient and surgeon criteria. Clinical findings determine the exact definition and direction of pseudoparesis and pseudoparalysis. Tear pattern and tissue quality determine if the rotator cuff is repairable or irreparable. Age and general health are important patient factors. Non-operative treatment is the first option for patients with a higher risk profile for reconstruction or arthroplasty, but delineation of its value requires better evidence. Tendon transfers are used for irreparable loss of the horizontal force couple balance (rotation). Options include latissimus dorsi, pectoralis minor and major for loss of active internal rotation, and latissimus dorsi ± teres major and lower trapezius for loss of active external rotation (AER). Partial cuff repair with or without superior capsular reconstruction using allograft or biceps tendon is an option for loss of active forward elevation. Treatment for the combined loss of elevation and external rotation patients is still not clear. Options include lateralised reverse shoulder arthroplasty (RSA) alone or combined RSA with a tendon transfer. RSA with loss of AER can be revised by adding a tendon transfer.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8965202PMC
http://dx.doi.org/10.1530/EOR-21-0070DOI Listing

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