Systematic review of reversing pseudoparalysis of the shoulder due to massive, irreparable rotator cuff tears

Background: Correcting pseudoparalysis of the shoulder due to massive rotator cuff tear is challenging. The most reliable treatment for restoring active shoulder elevation is debatable. Therefore, the purpose of this systematic review was to evaluate the success of various treatment options for reversing pseudoparalysis due to massive rotator cuff tear. Methods: A search was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta -Analyses (PRISMA) guidelines of the MEDLINE database, Cochrane database, Sportdiscus, and Google Scholar database for articles evaluating shoulder pseudoparalysis due to massive rotator cuff tears. Results: Nine articles evaluating reverse total shoulder arthroplasty (RTSA), superior capsular reconstruction (SCR), and rehabilitation programs were included in the study. Though there was variability, the definition of pseudoparalysis was active forward elevation (AFE) less than 90 degrees with preserved passive range of motion (ROM). Reversal of pseudoparalysis was defined as restoration of AFE greater than 90 degrees. The overall rate of reversal of pseudoparalysis across studies was similar for RTSA (96% +/- 17%) and SCR (94% +/- 3%). However, there was a difference in average improvement in AFE for RTSA (56 degrees +/- 11 degrees) and SCR (106 degrees +/- 20 degrees). A progressive rehabilitation pro- gram described improvements in a single study with 82% reversal of pseudoparalysis. Conclusion: The available Level IV evidence suggests that RTSA and SCR reliably reverse pseudoparalysis in most patients with massive, irreparable rotator cuff tears. However, the dissimilar improvements in ROM suggest that a more consistent definition of pseudoparalysis is warranted. Future randomized controlled trials are needed to determine the best treatment approach for patients with massive irreparable rotator cuff tears. Level of evidence: Level IV; Systematic Review (C) 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.