Saturday, November 29, 2014

Pseudoparalysis - what is it and what rotator cuff pathology is associated with it?

Fluoroscopic, magnetic resonance imaging, and electrophysiologic assessment of shoulders with massive tears of the rotator cuff.

These authors define pseudoparalysis as the painless inability to abduct the arm to 90 degrees with
a normal passive range of shoulder motion in the absence of neurologic impairment. They studied 20 shoulders (19 patients) with cuff tears involving the supraspinatus and infraspinatus of which nine had pseudoparalysis  and eleven did not.

They found no significant difference in fatty infiltration of the supraspinatus, infraspinatus, and teres minor or of the posterior tear extension between pseudoparalytic and non-pseudoparalytic shoulders. However, the pseudoparalytic shoulders had extension of the tear into the inferior half of the subscapularis.

They concluded that  the single most important predictor for preserved shoulder function in patients with massive cuff tearing is the integrity of the inferior subscapularis insertion. 

Comment: First of all, we really like this definition of pseudoparalysis. It is clear and easy to apply.
Secondly, this article emphasizes the role of the subscapularis in stabilizing the shoulder so that the deltoid can function in elevating the arm. It compresses the head into the concavity providing stability by concavity compression. The information in this article encourages us to repair the subscapularis whenever it is possible with the goal of minimizing the risk of pseudoparaysis and anterosuperior escape.


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