Pseudoparalysis and pseudoparesis of the shoulder

Abstract

Background Clinical presentation of massive rotator cuff tears range from pain to loss of active range of motion. Pseudoparalysis and pseudoparesis are defined inconsistently in the literature, but both include limited active with maintained passive range of motion. Objective This article aims to provide a consistent definition of pseudoparalysis and pseudoparesis of the shoulder and show structural and biomechanical differences between these two types of rotator cuff tear with their implications for treatment. Methods A literature review including key and basic papers discussing clinical symptoms, biomechanical differences, and their impact on therapeutic options for pseudoparalysis and pseudoparesis was performed. Results Biomechanically, structural differences between pseudoparalysis (active scapular plane abduction <45°) and pseudoparesis (active scapular plane abduction 45–90°) exist. For massive posterosuperior rotator cuff tears, the integrity of the inferior subscapularis tendon is the most predictive factor for active humeral elevation. Patients with pseudoparalysis have a higher grade of subscapularis tendon involvement (>50%) and fatty infiltration of the subscapularis muscle. Treatment options depend on the acuteness and repairability of the tear. Rotator cuff repair can reliably reverse the active loss of active range of motion in acute and reparable rotator cuff tears. In chronic and irreparable cases reverse total shoulder arthroplasty is the most reliable treatment option in elderly patients. Conclusion The most concise definition of pseudoparalysis is a massive rotator cuff tear that leads to limited active (<45° shoulder elevation) with free passive range of motion in the absence of neurologic deficits as the reason for loss of active elevation. The integrity of the subscapularis tendon is the most important difference between a pseudoparalytic and pseudoparetic (active shoulder elevation 45–90°) shoulder. Decision-making for surgical options depends more on reparability of the tendon tear and patient age than on differentiation between pseudoparalysis and pseudoparesis.

Massive Irreparable Rotator Cuff Tears: Which Patients Will Benefit from Physiotherapy Exercise Programs? A Narrative Review

“…The terms pseudoparesis and pseudoparalysis are used interchangeably and inconsistently in the literature related to MIRCT [ 8 , 9 , 35 ]. Some authors define pseudoparalysis as a massive rotator cuff tear that leads to a limited active forward flexion of less than or equal to 45° without passive restriction or neurological deficit, and that pseudoparesis differs only by having limited active forward flexion of greater than 45° and less than or equal to 90° [ 35 ].…”

“…These authors attempted to gain clarity on the terminology by defining pseudoparalysis as a massive rotator cuff tear with 0° of active elevation and full passive elevation, and pseudoparesis as a massive rotator cuff tear with less than 90° active elevation and full passive elevation. The lack of agreement on terminology was highlighted in another systematic review which identified that of the 16 studies included, four did not differentiate between pseudoparalysis and pseudoparesis, five studies did not define either, and seven studies had heterogenous definitions [ 8 ]. This lack of consensus is further highlighted by a survey of 246 shoulder surgeons which demonstrated a lack of agreement on how best to define pseudoparalysis, and low inter-rater agreement when assessing via a video consultation [ 36 ].…”

“…In cases of MIRCT, disruption of the activity of the rotator cuff can lead to unopposed action of the deltoid resulting in superior migration or superior and anterior subluxation [ 7 ]. This uncontrolled movement of the humeral head can lead to it abutting the coracoacromial arch, thus leading to a mechanical block to motion and a reduction in active movement [ 8 ]. When this reduction in active movement occurs, but full passive range of motion is preserved, it is called pseudoparesis or pseudoparalysis [ 9 ].…”

Aktuelle Aspekte der Behandlung der Rotatorenmanschette

“…gehören zu den häufigsten muskuloskeletalen Erkrankungen und können mit ausgeprägten Schmerzen und Funktionseinschränkungen -im Extremfall auch völligem Funktionsverlust der oberen Extremitäteinhergehen [10,61]. Die Prävalenz in der allgemeinen Bevölkerung ist besonders vom Alter, aber auch von Faktoren wie Händigkeit und Belastungsprofil abhängig und liegt zwischen 10 % in der jungen Erwachsenenbevölkerung und über 60 % in der Generation der über 80-Jährigen [49,75,82].…”