Massive irreparable tendon tears of the rotator cuff: salvage options.

The management of massive, irreparable rotator cuff tears is challenging. Arthroscopic débridement has produced reasonable short-term outcomes in patients who experience good relief from pain and improved range of motion after a subacromial injection with local anesthetic. Arthroscopic débridement with partial repair also has resulted in good outcomes, especially in patients with documented suprascapular nerve traction neurapraxia. Tendon transfer can offer a long-lasting solution in a patient with a weak shoulder who still has the ability to raise the shoulder past the horizontal position. Shoulder replacement with the use of a reverse prosthesis has emerged as a viable option in patients with pseudoparalysis with or without osteoarthritis of the glenohumeral joint.