AANA/SOMOS Enduring Shoulder Program 2024-Debate: 64 y/o Two-Star with Massive, Irreparable Rotator Cuff Tear and Pseudoparesis

Video Transcription

Video Summary

The discussion centers on treatment options for a 64-year-old with a massive irreparable rotator cuff tear and pseudoparesis, focusing on surgical choices: scope-assisted lower trapezius tendon transfer (SALT) versus superior capsule reconstruction (SCR) and reverse shoulder arthroplasty (RSA). SALT is favored for active patients without irreparable subscapularis damage who seek to maintain high physical demands, but requires a demanding six-month rehab and has a higher complication rate. SCR, initially popularized a decade ago, is now less favored due to limited success in cases with force coupling imbalances and pseudoparesis. RSA offers reliable pain relief, reproducible overhead function by six weeks, and durability, making it suitable for older, lower-demand patients or those unable to undergo extensive rehab. However, RSA often results in limited internal rotation affecting activities like dressing. Both speakers emphasize patient-specific factors, including physiologic age, activity goals, rehab availability, and expected outcomes, as critical in decision-making. Surgical pearls for SALT include careful dissection to avoid nerve injury and graft fixation techniques. The importance of precise clinical examination, including differentiating true pseudoparalysis from pain-limited motion via subacromial injections, guides treatment strategy. Overall, while RSA remains the more predictable and durable solution, SALT offers a valuable option for select high-functioning patients desiring to maintain strenuous activity levels.

Asset Caption

SALTT vs. SCR (Kyong Su Min, M.D.) vs. Reverse Prosthesis (Brian R. Waterman, M.D., FAANA)
Discussion, moderated by Michael A. Donohue, M.D.
Technique Video: Scope-Assisted Lower Trap Transfer (James R. Bailey, M.D., FAANA)

Keywords

rotator cuff tear

pseudoparesis

scope-assisted lower trapezius tendon transfer

superior capsule reconstruction

reverse shoulder arthroplasty

rehabilitation

patient-specific treatment