The reconstruction of massive rotator cuff tears achieves good clinical long-term results if the tendons remain intact. But even with a recurrent defect, the results have been better than in patients treated with a deltoid flap. In massive rotator cuff tears a thorough selection of the operative procedure regarding atrophy and fatty infiltration of the rotator cuff muscles as well as the tendon retraction and quality is mandatory.

In patients with therapy-resistant pain around the LHB, lesions of the reflection pulley need to be excluded beside more common causes of biceps problems. Arthroscopy is a reliable tool to assess these lesions. Therapy should address the definite pathology.

In the cadaver study, we found a good reproducibility of in-vivo conditions. We believe that ultrasonography is beneficial in follow-up evaluation after shoulder arthroplasty.