In this episode of HSS Presents, Dr. Samuel A. Taylor leads a dynamic roundtable with Drs. Christopher Brusalis, Michael Fu, and Chris Wilhelm, diving into the complex world of massive rotator cuff tears. The panel examines the nuances of diagnosing and treating these injuries, stressing the importance of patient-specific goals over blanket surgical approaches. From evaluating pseudo-paralysis to choosing between SCR, balloon spacers, and reverse arthroplasty, the discussion highlights cutting-edge strategies in rotator cuff management. With clinical anecdotes and lively debate, this episode offers practical pearls and a thoughtful approach to treating one of shoulder surgery's most debated challenges.