Decision-making for the treatment of pseudoparalytic shoulders is complex and a high level of experience in shoulder surgery and outcome evaluation is required. Management and results depend on clinical findings, tear and tissue quality, patient and surgeon criteria. Clinical findings determine the exact definition and direction of pseudoparesis and pseudoparalysis. Tear pattern and tissue quality determine if the rotator cuff is repairable or irreparable. Age and general health are important patient factors. Non-operative treatment is the first option for patients with a higher risk profile for reconstruction or arthroplasty, but delineation of its value requires better evidence. Tendon transfers are used for irreparable loss of the horizontal force couple balance (rotation). Options include latissimus dorsi, pectoralis minor and major for loss of active internal rotation, and latissimus dorsi ± teres major and lower trapezius for loss of active external rotation (AER). Partial cuff repair with or without superior capsular reconstruction using allograft or biceps tendon is an option for loss of active forward elevation. Treatment for the combined loss of elevation and external rotation patients is still not clear. Options include lateralised reverse shoulder arthroplasty (RSA) alone or combined RSA with a tendon transfer. RSA with loss of AER can be revised by adding a tendon transfer.

中文翻译：

---

了解肩部假性麻痹。第二部分：治疗。

治疗假性瘫痪肩部的决策是复杂的，需要高水平的肩部手术经验和结果评估。管理和结果取决于临床发现、撕裂和组织质量、患者和外科医生标准。临床发现确定了假性麻痹和假性麻痹的确切定义和方向。撕裂模式和组织质量决定了肩袖是可修复的还是不可修复的。年龄和一般健康状况是重要的患者因素。非手术治疗是重建或关节成形术风险较高的患者的首选，但对其价值的描述需要更好的证据。肌腱转移用于水平力偶平衡（旋转）的不可弥补的损失。选项包括背阔肌，胸小肌和大肌用于主动内旋的丧失，背阔肌±大圆肌和斜方肌下侧用于主动外旋（AER）的丧失。使用同种异体移植物或二头肌腱进行部分袖带修复，无论是否使用上囊重建，都是主动前抬高损失的一种选择。抬高和外旋联合丧失患者的治疗尚不明确。选项包括单独的侧向反向肩关节置换术 (RSA) 或将 RSA 与肌腱转移相结合。可以通过添加肌腱转移来修正 AER 缺失的 RSA。使用同种异体移植物或二头肌腱进行部分袖带修复，无论是否使用上囊重建，都是主动前抬高损失的一种选择。抬高和外旋联合丧失患者的治疗尚不明确。选项包括单独的侧向反向肩关节置换术 (RSA) 或将 RSA 与肌腱转移相结合。可以通过添加肌腱转移来修正 AER 缺失的 RSA。使用同种异体移植物或二头肌腱进行部分袖带修复，无论是否使用上囊重建，都是主动前抬高损失的一种选择。抬高和外旋联合丧失患者的治疗尚不明确。选项包括单独的侧向反向肩关节置换术 (RSA) 或将 RSA 与肌腱转移相结合。可以通过添加肌腱转移来修正 AER 缺失的 RSA。