Pseudoparalysis and pseudoparesis of the shoulder

Background Clinical presentation of massive rotator cuff tears range from pain to loss of active range of motion. Pseudoparalysis and pseudoparesis are defined inconsistently in the literature, but both include limited active with maintained passive range of motion. Objective This article aims to provide a consistent definition of pseudoparalysis and pseudoparesis of the shoulder and show structural and biomechanical differences between these two types of rotator cuff tear with their implications for treatment. Methods A literature review including key and basic papers discussing clinical symptoms, biomechanical differences, and their impact on therapeutic options for pseudoparalysis and pseudoparesis was performed. Results Biomechanically, structural differences between pseudoparalysis (active scapular plane abduction 50%) and fatty infiltration of the subscapularis muscle. Treatment options depend on the acuteness and repairability of the tear. Rotator cuff repair can reliably reverse the active loss of active range of motion in acute and reparable rotator cuff tears. In chronic and irreparable cases reverse total shoulder arthroplasty is the most reliable treatment option in elderly patients. Conclusion The most concise definition of pseudoparalysis is a massive rotator cuff tear that leads to limited active (<45° shoulder elevation) with free passive range of motion in the absence of neurologic deficits as the reason for loss of active elevation. The integrity of the subscapularis tendon is the most important difference between a pseudoparalytic and pseudoparetic (active shoulder elevation 45–90°) shoulder. Decision-making for surgical options depends more on reparability of the tendon tear and patient age than on differentiation between pseudoparalysis and pseudoparesis. = Hintergrund Rotatorenmanschettenmassenrupturen machen fast die Hälfte der behandelten Rotatorenmanschettenrupturen aus. Die klinische Symptomatik erstreckt sich von Schmerzen bis zum Verlust der aktiven Schultergelenkbeweglichkeit. Die Begriffe „Pseudoparalyse und Pseudoparese“ werden in der Literatur inkonsistent verwendet. Beiden Begriffen gemeinsam ist eine limitierte aktive bei simultan vorliegender freier passiver Schulterbeweglichkeit. Fragestellung Es soll eine konsistente Definition für Pseudoparalyse und Pseudoparese der Schulter erstellt werden. Die strukturellen und biomechanischen Unterschiede zwischen diesen beiden Typen von Rotatorenmanschettenrupturen werden aufgezeigt, sowie deren Einfluss auf die Behandlung analysiert. Methoden Eine Übersichtsarbeit über die Schlüssel- und Grundlagenstudien bezüglich klinischer Symptome, biomechanischer Unterschiede sowie deren Einfluss auf die Therapieoptionen für Pseudoparalyse und Pseudoparese wurde durchgeführt. Ergebnisse Biomechanisch bestehen strukturelle Unterschiede zwischen Pseudoparalyse (aktive Abduktion in der Skapulaebene unter 45°) und Pseudoparese (aktive Abduktion in der Skapulaebene zwischen 45 und 90°). Im Fall einer posterosuperioren Rotatorenmanschettenmassenruptur ist die Integrität des unteren Subskapularissehnenanteils der stärkste prädiktive Faktor für die aktive Elevation des Humerus. Patienten mit einer Pseudoparalyse haben häufig eine Rupturausdehnung in die untere Hälfte der Subskapularissehne sowie einen höheren Grad der fettigen Infiltration der Subskapularismuskulatur. Die therapeutischen Optionen sind abhängig vom Zeitpunkt und der Reparierbarkeit der Ruptur. Die Rekonstruktion einer akuten und rekonstruierbaren Rotatorenmanschettenruptur kann zuverlässig die aktive Beweglichkeit wiederherstellen. In chronischen und irreparablen Fällen variieren die therapeutischen Optionen von konservativ, partieller Rotatorenmanschettenrekonstruktion, superiorer Kapselrekonstruktion, zu Sehnentransfer und schließlich inverser Schulterprothese, wobei Letztere die zuverlässigste Behandlungsoption insbesondere bei älteren Menschen darstellt. Schlussfolgerung Die konsistenteste Definition für eine Pseudoparalyse der Schulter beinhaltet eine massive Rotatorenmanschettenruptur, die zu einer eingeschränkten aktiven (<45° Schulterelevation) bei freier passiver Schultergelenkbeweglichkeit – ohne neurologische Ursache für eine Paralyse – führt. Die Integrität der Subskapularissehne ist der wichtigste strukturelle Unterscheidungspunkt zwischen einer pseudoparalytischen und pseudoparetischen (aktive Schulterelevation zwischen 45 und 90°) Schulter. Die Entscheidungsfindung für die chirurgischen Therapieoptionen richtet sich mehr nach der Rekonstruktionsmöglichkeit einer Sehnenruptur und dem Alter des Patienten als nach der Differenzierung zwischen Pseudoparalyse und -parese

Functional and radiographic outcomes of reverse shoulder arthroplasty with a minimum follow-up of 10 years

Background: The use of reverse shoulder arthroplasty (RSA) is becoming increasingly prevalent. However, few studies have been published reporting the long-term outcomes of RSA. This study aims to report the clinical, radiographic, and patient-reported outcomes of the Delta Xtend reverse shoulder prosthesis, performed by a single surgeon and with a minimum follow-up of 10 years. Methods: All RSA procedures performed between 2005 and 2012 were identified. Patients were contacted and invited for a follow-up visit including clinical assessment, radiographs, and patient-reported outcome measures. Patients with a follow-up of less than 10 years were excluded. The revision-free implant survival was calculated at 10 years. Between 2005 and 2012, 119 procedures in 116 patients meeting inclusion criteria were identified. Of these patients, 35 were deceased before reaching the 10-year follow-up and 23 could not be reached. In total, 63 RSAs could be included in 61 patients (response rate: 75%). The median follow-up was 11.7 years (interquartile range [IQR]: 10.5-13.2). Results: Of the 61 patients, 7 patients underwent a revision after a median of 3 years (IQR: 0.2-9.8) during the total follow-up period. The 10-year implant survival was 94% (95% confidence interval: 84-98). At final follow-up, the median anterior elevation was 135° (IQR: 130°-160°), the median abduction was 120° (IQR: 100°-135°), and the median level reached with internal rotation was L5 (IQR: sacrum-L5). The median Auto-Constant score was 68 (IQR: 53-78), the median Subjective Shoulder Value was 80 (IQR: 70-93), and the median pain score was 0.2/10 (IQR: 0-2). In total, radiographs could be obtained in 25 patients (40%). Scapular notching occurred in 10 patients (40%), which was classified as Sirveaux-Nerot grade IV in 3 patients (12%). Ossification occurred in 10 patients (40%), and stress shielding in 2 patients (8%). Radiolucencies were observed around the humeral component in 24 patients (96%) and around the glenoid component in 13 patients (52%). Conclusion: The long-term results of RSA with a Delta Xtend prosthesis are favorable, with long-term improvement in range of motion and patient-reported outcome measures, and a satisfactory implant survival rate. Interestingly, the radiographical analysis showed high prevalence of signs associated with loosening, which did not seem to translate to high complication rates or inferior results.</p

Lateralising reverse shoulder arthroplasty using bony increased offset (BIO-RSA) or increasing glenoid component diameter:comparison of clinical, radiographic and patient reported outcomes in a matched cohort

Background: This study aims to compare the range of motion (ROM) of reverse shoulder arthroplasty lateralised by bony increased offset (BIO-RSA) using a standard 38-mm (mm) component to regular reverse shoulder arthroplasty (RSA) lateralised by using a 42-mm glenoid component. The secondary aims are to compare patient-reported and radiographic outcomes between the two groups. Materials and Methods: All patients with a BIO-RSA and size 38 glenosphere were retrospectively identified and matched to patients with a regular RSA and size 42 glenosphere. Matched patients were invited for a follow-up visit. ROM was assessed as well as radiographic outcomes (lateralisation, distalisation, inferior overhang, scapular notching, heterotopic bone formation, radiolucency, stress shielding, bone graft healing and viability and complications) and patient-reported outcomes (subjective shoulder value, Constant score, American Shoulder and Elbow Surgeons, activities of daily living which require internal rotation, activities of daily living which require external rotation and a visual analogue scale for pain). Outcomes were compared between the two groups. Results: In total, 38 BIO-RSAs with a size 38 glenosphere were matched to 38 regular RSAs with a size 42 glenosphere. Of the 76 matched patients, 74 could be contacted and 70 (95%) were included. At the final follow-up, there were no differences between the two groups in ROM, patient-reported outcomes or radiographic outcomes (p &gt; 0.485). Conclusions: Using a larger glenosphere is a feasible alternative to BIO-RSA for lateralising RSA, providing comparable ROM, patient-reported and radiographic results, while potentially decreasing costs, operative time and complication rates. Level of evidence III.</p

Reverse shoulder arthroplasty with a 155° neck-shaft angle inlay implant design without reattachment of the subscapularis tendon results in satisfactory functional internal rotation and no instability:a cohort study

Background: The aim of this study was to use the Activities of Daily Living which require Internal Rotation (ADLIR) questionnaire to assess the functional internal rotation in patients who had undergone reverse shoulder arthroplasty (RSA) without reattachment of the subscapularis (SSc) tendon at a minimum follow-up of 2 years. The secondary aim was to report the objective range of motion (ROM) and the rate of postoperative instability. Materials and methods: All consecutive primary RSA procedures without reattachment of the SSc tendon that were performed using a Delta Xtend prosthesis (an inlay system with a 155° neck-shaft angle) between January 2015 and December 2020 were identified to ensure a minimum follow-up of 2 years. Patients were contacted and requested to fill in several questionnaires, including the ADLIR and Auto-Constant scores. Results: In total, 210 patients met the inclusion criteria; among those patients, 187 could be contacted and 151 completed questionnaires (response rate: 81%). The SSc tendon was fully detached without repair in all cases, and a superolateral approach was used in 130 (86%) cases. The median follow-up was 4.5 years (range: 2.0–7.6). At final follow-up, the mean ADLIR score was 88/100 (interquartile range (IQR): 81–96). The median level reached in internal rotation was the 3rd lumbar vertebra (IQR: lumbosacral region—12th thoracic vertebra). Of the 210 eligible patients, one required a revision for a dislocation within the first month after primary surgery. With regards to regression analysis with ADLIR score as the outcome, none of the factors were associated with the ADLIR score, although age and smoking approached significance (0.0677 and 0.0594, respectively). None of the explanatory variables were associated with ROM in internal rotation (p &gt; 0.05). Conclusions: This study demonstrates that satisfactory ADLIR scores and internal rotation ROM were obtained at mid-term follow-up after RSA leaving the SSc detached. Leaving the SSc detached also did not lead to high instability rates; only one out of 210 prostheses was revised for dislocation within the first month after primary surgery. Level of evidence III.</p

GaN/Ga2O3 Core/Shell Nanowires Growth: Towards High Response Gas Sensors

International audienceThe development of sensors working in a large range of temperature is of crucial importance in areas such as monitoring of industrial processes or personal tracking using smart objects. Devices integrating GaN/Ga2O3 core/shell nanowires (NWs) are a promising solution for monitoring carbon monoxide (CO). Because the performances of sensors primarily depend on the material properties composing the active layer of the device, it is essential to control them and achieve material synthesis in the first time. In this work, we investigate the synthesis of GaN/Ga2O3 core-shell NWs with a special focus on the formation of the shell. The GaN NWs grown by plasma-assisted molecular beam epitaxy, are post-treated following thermal oxidation to form a Ga2O3-shell surrounding the GaN-core. We establish that the shell thickness can be modulated from 1 to 14 nm by changing the oxidation conditions and follows classical oxidation process: A first rapid oxide-shell growth, followed by a reduced but continuous oxide growth. We also discuss the impact of the atmosphere on the oxidation growth rate. By combining XRD-STEM and EDX analyses, we demonstrate that the oxide-shell is crystalline, presents the β-Ga2O3 phase, and is synthesized in an epitaxial relationship with the GaN-core

Functional and radiographic outcomes of reverse shoulder arthroplasty with a minimum follow-up of 10 years

Background: The use of reverse shoulder arthroplasty (RSA) is becoming increasingly prevalent. However, few studies have been published reporting the long-term outcomes of RSA. This study aims to report the clinical, radiographic, and patient-reported outcomes of the Delta Xtend reverse shoulder prosthesis, performed by a single surgeon and with a minimum follow-up of 10 years. Methods: All RSA procedures performed between 2005 and 2012 were identified. Patients were contacted and invited for a follow-up visit including clinical assessment, radiographs, and patient-reported outcome measures. Patients with a follow-up of less than 10 years were excluded. The revision-free implant survival was calculated at 10 years. Between 2005 and 2012, 119 procedures in 116 patients meeting inclusion criteria were identified. Of these patients, 35 were deceased before reaching the 10-year follow-up and 23 could not be reached. In total, 63 RSAs could be included in 61 patients (response rate: 75%). The median follow-up was 11.7 years (interquartile range [IQR]: 10.5-13.2). Results: Of the 61 patients, 7 patients underwent a revision after a median of 3 years (IQR: 0.2-9.8) during the total follow-up period. The 10-year implant survival was 94% (95% confidence interval: 84-98). At final follow-up, the median anterior elevation was 135° (IQR: 130°-160°), the median abduction was 120° (IQR: 100°-135°), and the median level reached with internal rotation was L5 (IQR: sacrum-L5). The median Auto-Constant score was 68 (IQR: 53-78), the median Subjective Shoulder Value was 80 (IQR: 70-93), and the median pain score was 0.2/10 (IQR: 0-2). In total, radiographs could be obtained in 25 patients (40%). Scapular notching occurred in 10 patients (40%), which was classified as Sirveaux-Nerot grade IV in 3 patients (12%). Ossification occurred in 10 patients (40%), and stress shielding in 2 patients (8%). Radiolucencies were observed around the humeral component in 24 patients (96%) and around the glenoid component in 13 patients (52%). Conclusion: The long-term results of RSA with a Delta Xtend prosthesis are favorable, with long-term improvement in range of motion and patient-reported outcome measures, and a satisfactory implant survival rate. Interestingly, the radiographical analysis showed high prevalence of signs associated with loosening, which did not seem to translate to high complication rates or inferior results.</p

All-Endoscopic Treatment of Acromioclavicular Joint Dislocation: Coracoclavicular Ligament Suture and Acromioclavicular Ligament Desincarceration

Acute acromioclavicular (AC) joint dislocations are common and difficult to manage. The physiopathologic pattern begins with the rupture of the AC ligaments, then the coracoclavicular (CC) ligaments, and with an invasion of the clavicle through the deltotrapezial fascia. Therefore, we tend to perform a true suture of the CC ligaments, along with a release of the AC ligaments from the joint. We thus propose an all-endoscopic CC ligament suture and AC joint release. It starts with glenohumeral exploration enabling a repair of concomitant lesions when necessary. Dissection of the coracoid process is made, along with the lateral border of the conjoint tendon, medially the pectoralis minor tenotomy, and plexus brachial exposition and protection. Superiorly the CC ligaments are tagged and exposed. A major difference with others procedure then arises. We dissect the inferior and superior surfaces of the clavicle and the AC joint, although we maintain the continuity between the deltotrapezoid fascia and the AC ligaments. The AC dislocation is reduced under endoscopic control performing a true suture of the CC ligaments by the mean of 2 suture tapes and dog bones. After surgery, a shoulder brace is used for 6 weeks. Physiotherapy then begins