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The mean Constant score improved from 25 ± 11 to 59 ± 8. Active internal rotation did not significantly change (p = 0.332). At long-term follow-up, RSA combined with modified L'Episcopo procedure resulted in significant improvements in pain, range of motion, and functional scores for patients with shoulder pseudoparalysis and a lack of active external rotation caused by a massive posterosuperior cuff tear with a teres minor deficiency. At long-term follow-up, RSA combined with modified L'Episcopo procedure re