 Complex Rotary Cuff tears, whether well in the front or well in the back of the shoulder can be very difficult to treat. In our young active patients with pain and loss of strength, we can move muscles from somewhere else to make a new Rotary Cuff. My name is Dr. Mohit Glotra, Associate Professor of Orthopedics at the University of Maryland School of Medicine, and today we're drawing outside the lines. So the shoulder is a ball and socket joint, and the Rotary Cuff is a group of muscles and tendons that covers that entire ball. Now sometimes you can have a very painful Rotary Cuff tear that is too difficult to treat. So instead of being here on the ball at this location, it is pulled back into the chest here. Now our typical treatment for this type of tear is to try to pull that tendon over and attach it to the bone. But once this distance is too far, the chance of failure for a repair like that is very high. So another option is to take muscles and tendons that are close by and move them to a new location. So your pec muscle, which is here, turns into a tendon that attaches to the bone there. In addition, your latissimus tendon sits close by just behind it. So when you're trying to compensate for this Rotary Cuff that's torn, you can detach a portion of these tendons and move them all the way up to this location here. So they're located usually down here and you're moving them up a short way to its new location where the Rotary Cuff used to be. In this scenario, although the recovery can be up to six or nine months because you're training new muscles to do new things, in the final recovery you can have excellent pain relief, restoration of your motion, and even regain strength. So in summary, when you have a large, irreparable Rotary Cuff tear, whether in the front or the back of your shoulder, a muscle transfer can help restore function, give pain relief, and get people back to an active lifestyle.