Massive rotator cuff tears can cause loss of function and workforce. It is among the most often seen orthopedic problems and may be very resistant to non-operative treatment. The concept of massive tear has been described in various ways. As the rotator cuff and the capsule fuse at their insertion, they may cleave together in full-thickness tears. The most commonly torn cuff element is the supraspinatus tendon. According to Neer, that`s because of the critical zone defined by him. Acromion types and smoking also plays an important role in the etiology of rotator cuff tears. Imaging methods are widely used in the diagnosis of the tears. MR and US imaging are the more commonly used two methods. There is a wide spectrum of surgical options and the treatment should be personalized.