Background: Surgeons tend to associate pseudoparesis with massive rotator cuff tears. However, little is known about the degree to which isolated subscapularis tears might be associated with pseudoparesis of the shoulder. Question/purpose: Is the extent of subscapularis tears associated with pseudoparesis? Methods: A retrospective analysis identified all patients with subscapularis tears from 2010 to 2021 in the longitudinally maintained shoulder arthroscopy archive of one university hospital’s shoulder section of the orthopaedic department. After exclusion, 106 of 152 patients with isolated subscapularis tears who underwent arthroscopic surgery were included in the study. Sixty percent of the patients were women, and the mean ± SD age was 52 ± 11 years. Patients who were scheduled for arthroscopic surgery were divided into two groups according to the presence or absence of pseudoparesis preoperatively. Pseudoparesis was considered to be active forward elevation > 45º but < 90º, which is a simple and reproducible measurement that can be taken using a goniometer, and demonstrated complete passive forward elevation. Pseudoparesis was present in 41% (43 of 106) of patients with an isolated subscapularis tear. Data on tear severity (according to Lafosse type, noted during arthroscopy), integrity of the subscapularis tendon (noted during arthroscopy), fatty degeneration (using the Goutallier grading system on MRI), arthroscopic findings of biceps disorder, superior labrum anterior to posterior (SLAP) lesions, and pain severity (measured by VAS score) were recorded. We used logistic regression analysis to examine the relationship between pseudoparesis and disruption of the tendinous part of the subscapularis. Results: After accounting for potentially confounding factors such as biceps disorders and muscle atrophy, we found that pseudoparesis was associated with decreased tear severity according to the Lafosse classification (adjusted OR 0.2 [95% CI 0.1 to 0.7]; p = 0.01) and with disruption of the tendinous portion of the subscapularis (adjusted OR 21 [4 to 128]; p = 0.001). Patients with less severe tears (Lafosse type I) have lower odds of experiencing pseudoparesis compared with those with more severe tears (Lafosse types II, III, and IV), and patients with disruption of the tendinous portion of the subscapularis have substantially higher odds of pseudoparesis compared with those with an intact tendinous portion. No association was found between pseudoparesis and subscapularis fatty degeneration, biceps disorder, or SLAP lesions. Conclusion: This study provides initial evidence suggesting that isolated subscapularis tears are associated with pseudoparesis. The main finding of this study is that isolated subscapularis tears that involve the tendon extending to the inferior part of the subscapularis have higher odds of being found with pseudoparesis. These findings highlight the importance of maintaining the integrity of the superior tendinous part of the subscapularis for active forward elevation > 90°. Level of Evidence: Level III, therapeutic study.

Background: YouTube is a widely accessible platform that facilitates the rapid dissemination of both evidence-based and potentially misleading health-related information. This study assesses the educational quality, reliability, and comprehensiveness of the most-viewed YouTube videos about scapular dyskinesis.Methods: A systematic search was conducted on YouTube using the keywords "scapular dyskinesia" and "scapular dyskinesis." The top 100 videos for each keyword were screened for inclusion, and the metrics, sources, and content of the included videos were analyzed. Video quality and reliability were assessed using the Global Quality Scale and the modified DISCERN scale, respectively. In addition, a newly developed, non-validated tool, Scapular Dyskinesis Specific Scoring, was used to provide a condition-specific content assessment.Results: The analysis revealed that 48.1% of the videos were low quality, and 62.0% lacked reliability. Videos produced by health-related websites exhibited superior quality. Content focusing on treatment and diagnostic approaches demonstrated significantly higher quality than other content categories (P<0.001). A correlation analysis indicated that the video power index did not correlate significantly with reliability, quality, or comprehensiveness scores. Additionally, a simple regression analysis revealed that the video upload time negatively affected the quality, reliability, and comprehensiveness metrics.Conclusions: Most YouTube videos on scapular dyskinesis were of low quality, lacked reliability, and failed to provide comprehensive and accurate information. Furthermore, high-quality and reliable content tended to receive relatively low engagement and user preference scores. These findings underscore the urgent need for well-structured, evidence-based, and regularly updated YouTube content about scapular dyskinesis.Level of evidence: IV.

For patients undergoing arthroscopic rotator cuff repair surgery (RCR), it is crucial to prevent falls to minimize the risk of re-tearing the repaired muscles. Shoulder immobilization during the postoperative period may lead to a decline in postural balance. This prospective cohort study aimed to investigate the postural balance of patients in the early postoperative period following arthroscopic RCR. Thirty-five patients (17 female/18 male, aged 49.56 ± 13.41 years) were assessed preoperatively, on the postoperative day 2, and at the postoperative week 6. Postural balance was evaluated using the Overall Stability Index (OSI), Antero-Posterior Stability Index (API), Medio-Lateral Stability Index (MLI), and Limits of Stability (LOS) tests conducted with the Biodex Balance System. Additionally, the Visual Analog Scale (VAS) pain score and Constant-Murley Score were recorded. The OSI and API values recorded on both postoperative day 2 and postoperative week 6 were statistically significantly worse than preoperative values. (p = 0.02, p = 0.03, respectively). Conversely, no statistically significant differences were observed across all three measurements for the MLI and LOS values (p > 0.05). The VAS score demonstrated a statistically significant decrease, while the Constant-Murley Score exhibited a statistically significant increase at the final measurement (both p < 0.001). This study highlights that postural stability significantly declines during the early postoperative period following arthroscopic rotator cuff repair, with specific impairments in anterior-posterior stability, despite improvements in pain and shoulder function. These findings underscore the need for early, targeted rehabilitation interventions to address balance deficits and reduce the risk of falls, potentially improving overall recovery outcomes.

Introduction: The present study aimed to determine the prevalence of concomitant inferior labrum tears in patients with superior labrum anterior posterior (SLAP) lesions, and evaluate the clinical outcomes of arthroscopic inferior labrum repair performed concurrently with SLAP lesion management. Materials and methods: This retrospective case series was conducted on patients who underwent shoulder arthroscopy for SLAP lesions between 2017 and 2022. The study group included patients who had SLAP lesion treatment (tenotomy, tenodesis, or repair) and inferior labrum tear repair, with a minimum follow-up of 24 months. Demographic data and clinical characteristics of the patients were assessed. Outcomes were evaluated using the Oxford Shoulder Score (OSS), Subjective Shoulder Value (SSV), and Visual Analogue Scale (VAS). Furthermore, the proportion of patients who met the Minimal Clinically Important Difference (MCID), Substantial Clinical Benefit (SCB), and Patient Acceptable Symptom State (PASS) thresholds for the patient-reported outcome measures (PROMs) were determined. Results: A concomitant inferior labrum tear was identified in 11% ( n = 32) of 278 patients who underwent surgery for SLAP lesions. Among these, 26 patients (mean age, 43.6 ± 9.8 years; 50% male/female; 77% dominant extremity involvement; mean follow up, 46.8 ± 20.5 months) who met inclusion criteria were included in the study. 17 (65%) patients had a history of sudden arm traction during heavy lifting. Significant improvements in PROMs were observed at the final follow-up ( p <.001 for all scores). The rates of patients achieving MCID, PASS, and SCB were determined, respectively, OSS (96%, 81%, 84%), SSV (100%, 77%, 84%), and VAS (88%, 81%, 81%). Conclusions: Inferior labrum tears are a pathological condition that may accompany SLAP lesions, and patients with both lesions usually have a history of traction-related injuries. In these cases, successful clinical outcomes could be achieved through patient-specific management of the SLAP lesion and repair of the inferior labrum. Level of evidence: Level IV, therapeutic study, retrospective case series.