Background: The loss of active elevation of shoulder is known as pseudoparalysis, and this is caused by the result of rotator cuff deficient arthropathy (RCDA). We have performed humeral head replacement using the small size head to repair RC tear. In this study we evaluated the outcome of this procedure and discussed what factors affected this in patients with pseudoparalysis.
Methods: Twenty-three shoulders for 22 patients in which flexion was 60° or less were considered as pseudoparalysis and underwent surgery based on our strategy. Tendon transfer was provided for 1 shoulder from Pectoralis major and for 6 shoulders from Latissimus dorsi. Range of shoulder motion was compared between pre and post-surgery, and gender, age, tendon transfer and fatty degeneration in RC were evaluated between good (≥100°) and poor (< 100°) flexion groups after surgery.
Results: Flexion, external rotation and JOA score were significantly improved after surgery. In 19 of 23 patients, flexion was improved more than 100°. We could not find the factors which were responsible for good flexion; however, fatty degeneration in supraspinatus and infraspinatus muscle was found by MRI image in the group in which external rotation was poor, even though flexion was improved.
Conclusion: Reverse shoulder arthroplasty has proven effective in treating RCDA and restoring active elevation, although it does not restore active external rotation. Our procedure using the small size head and RC repair may be suitable for patients with pseudoparalysis to restore both flexion and external rotation unless fatty degeneration is found in RC.
