(i) The management of irreparable rotator cuff tears

The management of massive irreparable rotator cuff tears can be challenging. There are, however, a number of operative and non-operative options available to the shoulder surgeon.Non-operative management with simple analgesics, steroid injections and a deltoid re-education programme may be appropriate for patients with few symptoms, particularly elderly, lower demand patients with lower expectations. In more symptomatic patients, especially younger patients with higher demands, surgical intervention may be considered. Arthroscopic debridement and/or, sub-acromial decompression (with or without biceps tenotomy) may suffice, but partial or augmented rotator cuff repair or tendon transfer surgery is available. In the presence of arthrosis, cuff tear arthroplasty or reverse geometry arthroplasty are valid options.Treatment should be individualized depending on the patient's symptoms, age, expectations, needs and the presence or absence of associated glenohumeral joint arthrosis.