Management of irrepairable cuff tears generally depends on the age. In the elderly low demand patients, a reverse total shoulder arthroplasty yields satisfactory results. In the younger patients, the options are controversial and currently there is no clear evidence. Various options like Cuff tear arthropathy head hemiarthoplasty, muscle/ tendon transfers, autografts ( fascia illiaca), allografts ( synthetic), superior capsular reconstruction, balloon interposition arthroplasty and shoulder fusion have been described. A total shoulder arthroplasty if performed for a cuff deficient shoulder will result in failure of the glenoid component secondary to the rocking horse phenomenon.