In this lecture, I talk about the management of massive irreparable rotator cuff tears and summarise the literature in the area including my own research to help provide insight into what we should do clinically. I then provide guidance on the key components of the physiotherapy assessment and targeted treatment with these patients.

Key learning points

• What are massive irreparable rotator cuff tears?
  • Radiological features, patient characteristics, biomechanics
• What are the treatment options?
  • Surgical & non-surgical
• The challenges of clinical decision-making
• Overview of physiotherapy programmes for massive irreparable rotator cuff tears
  • Content, evidence, efficacy
• What are the prognostic factors for success with physiotherapy?
• Results of our international Delphi study
• What are the key components of the physiotherapy assessment?
• What are the key elements of targeted physiotherapy intervention?