Pseudoparalysis: a systematic review of term definitions, treatment approaches, and outcomes of management techniques.

BACKGROUND: Pseudoparalysis remains one of the most challenging conditions in shoulder surgery. Long thought of as an unsolvable problem, recent advances in surgical techniques offer potential return of overhead motion in the setting of massive irreparable rotator cuff tears. This article summarizes the available literature including existing definitions and the results of different treatment approaches regarding range of motion, outcome scores, and reversal. METHODS: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review of the MEDLINE database, Cochrane database, Physiotherapy Evidence Database, and Google Scholar database was performed for studies that defined a preoperative shoulder group as having pseudoparalysis. A secondary search included preoperative active forward elevation less than 90°. RESULTS: In 16 studies, the most consistent definition was a massive rotator cuff tear with active elevation less than 90°, but studies inconsistently included stiffness, external rotation loss, arthritic changes, neurologic status, and pain. There were 6 different techniques: nonoperative rehabilitation, rotator cuff repair, muscle transfer, hemiarthroplasty, reverse total shoulder arthroplasty, and reverse total shoulder arthroplasty with muscle transfer. Postoperatively, all approaches showed improvement. CONCLUSION: Pseudoparalysis of the shoulder has a variable definition in the literature without consideration of degree or substratification of other confounders such as the presence of arthritis or pain. Thus the literature supports treating this condition with any variety of treatment. We propose that pseudoparalysis be more restrictively defined to allow comparisons. In addition, we propose an algorithm to serve as a treatment guideline to aid in surgical decision making for this condition.

Arthroscopic Remplissage for Moderate-Size Hill-Sachs Lesion.

Humeral bone loss has been shown to be a risk factor for failure after arthroscopic treatment of instability. We present the arthroscopic remplissage technique originally described by Koo and Burkhart et al. with a modification in the percutaneous anchor placement and suture tying that is reproducible and effective. We percutaneously place 2 suture anchors, which require no additional suture passing across the tissue, to create a double pulley technique, filling the defect with posterior capsule and rotator cuff. Therefore, the Hill-Sachs defect becomes extra-articular, eliminating the potential engagement of the anterior glenoid and contribution to recurrence of instability. This technique is applicable broadly for most Hill-Sachs lesions that need addressing. By not having to pass or shuttle any suture through tissue after anchor placement and by eliminating the necessity to go subacromially to retrieve or tie suture, the technique saves time and improves reproducibility. The compression of tissue into the Hill Sachs surface area also is improved by double-reinforced suturing through the double-pulley technique. The combination of these advantages creates a sound and efficient technique for remplissage.

Implementation of a Comprehensive Orthopaedic Registry System.

Advances in information technology have allowed for improvements in the collection and analysis of large-scale outcomes data. These data can be used in the practice of orthopaedics for benchmarking, value analysis, and comparative effectiveness research. The implementation of registries within a busy surgical practice can be challenging, costly, and inefficient. Content, platform, and characteristics are the key elements required to successfully implement a patient-based orthopaedic outcomes data registry. Specific barriers to implementing registries are discussed, and solutions are proposed, to provide an example for optimal integration within clinical practices that may have varying goals.