The Reverse Shoulder Arthroplasty has revolutionized the management of complex shoulder pain and dysfunction due to rotator cuff tear arthropathy since its FDA approval in 2003. The indications for the use of the Reverse Shoulder Arthroplasty continue to expand and early results are encouraging for patients with arthritis in the setting of a massively torn rotator cuff. However, the role of the Reverse Shoulder Arthroplasty to manage pain secondary to osteoarthritis of the shoulder in the setting of an intact rotator cuff with underlying age-related rotator cuff degeneration is not clear and remains a challenging clinical question. This question continues to gain significance as the number of patients with shoulder arthritis is rapidly growing as is the number of arthroplasty procedures performed annually.