The treatment of massive rotator cuff tears remains a clinical challenge, as it not only presents high surgical difficulty and poor prognosis but also significantly increases the rate of retearing after repair. The main manifestations of irreparable rotator cuff tears are shoulder joint pain, weakness, and pseudoparalysis. Imaging examination can evaluate the size of rotator cuff injury, muscle atrophy, degree of muscle contraction, grading of fat infiltration, and humeral head displacement. The correct treatment plan should be selected based on the patient’s condition. For elderly patients, if the shoulder joint function is basically good, arthroscopic debridement, biceps tendon release, amputation, or tendon fixation surgery can be considered, while repairing part of the rotator cuff; For patients with irreparable massive rotator cuff tears accompanied by pseudoparalysis, patch techniques, superior capsule reconstruction, and transposition of the long head tendon of the biceps brachii muscle, or reverse total shoulder replacement surgery may be considered. For young patients, the main focus is on restoring rotator cuff muscle strength, and transfer surgery to the latissimus dorsi tendon and pectoralis major muscle can be used. For individuals with intact subscapularis muscle, latissimus dorsi muscle transfer can improve lateral rotation and partial lift function [1]. For simple irreparable tears of the subscapularis muscle, transfer of the pectoralis major tendon can help patients recover internal rotation of the shoulder joint. For irreparable ipsilateral supraspinatus muscle tears, this method may be ineffective [2].