Relationship between massive chronic rotator cuff tear pattern and loss of active shoulder range of motion

• Published in: Journal of shoulder and elbow surgery Vol. 23; no. 8; pp. 1195 - 1202
• Main Authors: Collin, Philippe, MD, Matsumura, Noboru, MD, Lädermann, Alexandre, MD, Denard, Patrick J., MD, Walch, Gilles, MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01-08-2014
• Subjects: active range of motion; Aged; Aged, 80 and over; Arthrography; Chronic Disease; classification; Female; Humans; Male; massive rotator cuff tear; Middle Aged; Muscle, Skeletal - diagnostic imaging; Muscle, Skeletal - physiopathology; Orthopedics; pseudoparalysis; Range of Motion, Articular; Rotator Cuff - diagnostic imaging; Rotator Cuff - physiopathology; Rotator Cuff Injuries; Shoulder; Shoulder Joint - diagnostic imaging; Shoulder Joint - physiopathology; subscapularis tear; Tendon Injuries - classification; Tendon Injuries - diagnostic imaging; Tendon Injuries - physiopathology; Tomography, X-Ray Computed; massive rotator cuff tear; Shoulder; active range of motion; Cross-Sectional Study; pseudoparalysis; classification; subscapularis tear; Level III
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2013.11.019

Background Management of massive chronic rotator cuff tears remains controversial, with no clearly defined clinical presentation as yet. The purpose of the study was to evaluate the effect of tear size and location on active motion in patients with chronic and massive rotator cuff tears with severe muscle degeneration. Methods One hundred patients with massive rotator cuff tears accompanied by muscle fatty infiltration beyond Goutallier stage 3 were prospectively included in this study. All patients were divided into 5 groups on the basis of tear pattern (supraspinatus, superior subscapularis, inferior subscapularis, infraspinatus, and teres minor). Active range of shoulder motion was assessed in each group and differences were analyzed. Results Active elevation was significantly decreased in patients with 3 tear patterns involved. Pseudoparalysis was found in 80% of the cases with supraspinatus and complete subscapularis tears and in 45% of the cases with tears involving the supraspinatus, infraspinatus, and superior subscapularis. Loss of active external rotation was related to tears involving the infraspinatus and teres minor; loss of active internal rotation was related to tears of the subscapularis. Conclusions This study revealed that dysfunction of the entire subscapularis and supraspinatus or 3 rotator cuff muscles is a risk factor for pseudoparalysis. For function to be preserved in patients with massive chronic rotator cuff tears, it may be important to avoid fatty infiltration with anterior extension into the lower subscapularis or involvement of more than 2 rotator cuff muscles.