Symptomatic irreparable rotator cuff tears pose a challenge for shoulder surgeons. Whilst reverse polarity shoulder arthroplasty is an effective option for older symptomatic patients who have exhausted conservative management, the optimal treatment for younger patients remains controversial. In this article we outline the main tendon transfer options, including anatomical considerations, indications, contraindications, surgical technique, complications and a review of the evidence. Tendon transfers provide an alternative joint-preserving surgical option, but the evidence so far is limited, with a clear need for well-designed comparative studies to confirm their effectiveness.

The rotator cuff interval (RCI) is an important and anatomically complex region of the rotator cuff that is critically important to normal glenohumeral function. Recognition of common pathologies in this region on imaging examinations is especially important as injuries may be difficult to detect on clinical examination and even at arthroscopy. Familiarity with the magnetic resonance imaging appearance of the normal and abnormal RCI and the ability to convey findings to orthopedic and sports medicine referrers are essential to facilitate prompt creation of effective treatment plans.