The scenario of age-associated rotator cuff degeneration in conjunction with chronic osteoarthritis is a common clinical presentation. The shoulder with chronic osteoarthritis in the setting of a degenerative or atrophic rotator cuff presents a challenging clinical question. From a management standpoint the question arises of whether the patient would be best served with a total shoulder arthroplasty or a reverse shoulder arthroplasty. A total shoulder arthroplasty is the gold standard arthroplasty option but requires an intact and functional rotator cuff to function properly and an elderly patient is more likely to have rotator cuff degeneration and dysfunction. Rotator cuff dysfunction may be revealed early after undergoing a total shoulder arthroplasty and range of motion improves. Secondary rotator cuff dysfunction after total shoulder arthroplasty is becoming an increasingly recognized entity and clinical challenge.13 Conversely, a reverse shoulder arthroplasty does not require a functional rotator cuff and has been noted to have promising results but is an arthroplasty option with less predictable outcomes and less clinical follow-up.