This PRISMA-compliant systematic review examines 16 studies on shoulder pseudoparalysis, analyzing how the term is defined and what outcomes each treatment approach achieves. The central problem: no two studies define pseudoparalysis the same way, making treatment comparisons nearly meaningless. The authors propose a restrictive redefinition and a treatment algorithm to fix this.
The shoulder literature had been using 'pseudoparalysis' to describe everything from a painful shoulder with 80° of elevation to a completely flail arm with anterior-superior escape — a definition so broad it was clinically useless.
This paper gives you a testable, actionable framework. Before you label a shoulder pseudoparalytic, inject it: if motion returns, the problem is pain, not structural failure of the force couple. Only after pain is excluded does the classification apply.
Once confirmed, the distinction matters for surgery. Pseudoparesis (<90° elevation, no escape) can respond to cuff repair, SCR, or rehabilitation depending on patient age and tissue quality. True pseudoparalysis (0° elevation, anterior-superior escape) requires RSA. No soft-tissue procedure has been shown to reliably restore elevation in this setting.
Don't forget the external rotation axis: a patient with ER pseudoparalysis (lags to -40°) needs either a lateralized RSA implant or a combined RSA with latissimus/teres major transfer. Restoring elevation without addressing ER leaves patients functionally disabled for activities of daily living.
This PRISMA-compliant systematic review examines 16 studies on shoulder pseudoparalysis, analyzing how the term is defined and what outcomes each treatment approach achieves. The central problem: no two studies define pseudoparalysis the same way, making treatment comparisons nearly meaningless. The authors propose a restrictive redefinition and a treatment algorithm to fix this.
The shoulder literature had been using 'pseudoparalysis' to describe everything from a painful shoulder with 80° of elevation to a completely flail arm with anterior-superior escape — a definition so broad it was clinically useless.
This paper gives you a testable, actionable framework. Before you label a shoulder pseudoparalytic, inject it: if motion returns, the problem is pain, not structural failure of the force couple. Only after pain is excluded does the classification apply.
Once confirmed, the distinction matters for surgery. Pseudoparesis (<90° elevation, no escape) can respond to cuff repair, SCR, or rehabilitation depending on patient age and tissue quality. True pseudoparalysis (0° elevation, anterior-superior escape) requires RSA. No soft-tissue procedure has been shown to reliably restore elevation in this setting.
Don't forget the external rotation axis: a patient with ER pseudoparalysis (lags to -40°) needs either a lateralized RSA implant or a combined RSA with latissimus/teres major transfer. Restoring elevation without addressing ER leaves patients functionally disabled for activities of daily living.