<p>Rotator cuff tears, often caused by degeneration, trauma, or repetitive use, can severely affect shoulder function. Pseudoparalysis, characterized by the inability to elevate the arm despite normal passive range of motion, is a challenge in massive tears. This study aimed to evaluate the association between radiological parameters on X-ray and MRI and pseudoparalysis/pseudoparesis in patients with large to massive rotator cuff tears. A retrospective cohort study was conducted on 58 patients who underwent arthroscopic surgery for large to massive rotator cuff tears between 2018 and 2024. Patients were categorized based on shoulder abduction and flexion: Group 1 (0–45°, pseudoparalysis), Group 2 (45–90°, pseudoparesis), and Group 3 (&gt; 90°, near-normal motion). For abduction, Groups 1, 2, and 3 consisted of 14, 27, and 17 patients, respectively, while the corresponding group sizes for flexion were 13, 26, and 19. Preoperative X-rays and MRI assessed the critical shoulder angle (CSA), acromiohumeral distance (AHD), and muscle integrity. Intraoperative findings detailed tendon tears. Higher Patte stages and a greater number of torn tendons were significantly associated with reduced abduction and flexion ROM (p &lt; 0.001). AHD correlated with greater ROM in abduction and flexion (respectively p = 0.006, p = 0.033), while CSA and tangent sign showed no significant association. Subscapularis involvement correlated with reduced abduction (p = 0.021). Comorbidities like diabetes, hyperlipidemia, and smoking had no significant effect on ROM. The number of torn tendons, Patte stage, and reduced acromiohumeral distance were significantly associated with pseudoparalysis. When physical examination is limited, these imaging findings may be more frequently observed in patients with pseudoparalysis or pseudoparesis; however, they should be interpreted in conjunction with clinical evaluation.</p><p>Level of Evidence: Level 3</p>