The massive rotator cuff tear continues to present physicians with one of the most challenging pathologic conditions affecting the shoulder. Advances in diagnostic imaging and clinical experience have improved over the last decade. These advances have led to an evolution in the treatment of these tears. Magnetic resonance imaging has become the new gold standard for diagnosing rotator cuff tears. Quantification of muscle atrophy has emerged as a new area of research and provides prognostic information toward patient outcome. Treatment options include debridement, biceps tenotomy, direct repair, tendon transfer, and tendon transposition. Current results from these options are highlighted in this review.
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