title: Relationship between massive chronic rotator cuff tear pattern and loss of active shoulder range of motion.
abstract: 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.
authors.affiliation: Saint-Grégoire Private Hospital Center, Saint-Grégoire, France. Electronic address: collin.ph@wanadoo.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Collin
authors.affiliation: Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Matsumura
authors.affiliation: Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Lädermann
authors.affiliation: Southern Oregon Orthopedics, Medford, OR, and Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Denard
authors.affiliation: Santy Orthopaedic Center and Jean-Mermoz Private Hospital, Lyon, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Walch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001175:Arthrography; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000503:physiopathology; D016059:Range of Motion, Articular; D017006:Rotator Cuff / Q000000981:diagnostic imaging / Q000503:physiopathology*; D000070636:Rotator Cuff Injuries; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000503:physiopathology*; D013708:Tendon Injuries / Q000145:classification* / Q000000981:diagnostic imaging / Q000503:physiopathology; D014057:Tomography, X-Ray Computed
keywords: Shoulder; active range of motion; classification; massive rotator cuff tear; pseudoparalysis; subscapularis tear