Monday, June 17, 2024

Pseudoparalysis?

What is pseudoparalysis? An international group of 26 experienced shoulder surgeons tried to answer this question using a a modified Delphi process as reported in Defining Pseudoparalysis & Pseudoparesis - A Consensus Study

The term "pseudoparalysis " is often used to describe a shoulder with preserved passive motion but lacks the ability to actively elevate the arm.

In some cases, the diagnosis is apparent.


However,  in the above referenced article, there was lack of consensus about the thresholds of motion necessary to make the diagnosis of pseudoparalysis. This is particularly an issue in the stiff shoulder.



An imporant question is "why does all this matter"?  There seems to be at least two reasons: (1) the ranges of active and passive motion help determine treatment (e.g. anatomic vs reverse total shoulder) and (2) these ranges are important measures of the success of treatment.

Perhaps the most practical and least controversial approach is to simply document the range of passive humero-scapular flexion



and the range of active humero-scapular flexion

These two simple measures may be more helpful in guiding treatment and in documenting treatment effectiveness than wondering if the shoulder is pseuoparalytic or pseudoparetic.

Lord Kelvin 1824–1907: "When you can measure what you are speaking about, and express it in numbers, you know something about it; but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meagre and unsatisfactory kind: it may be the beginning of knowledge, but you have scarcely, in your thoughts, advanced to the stage of science, whatever the matter may be"

It is of note that we measure humerothoracic not glenohumeral motion. Thus the motion of the scapula on the chest wall and the motion of the humerus with respect to the scapula are included.'


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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).

Shoulder rehabilitation exercises (see this link).