Tears involving the muscles of the rotator cuff demonstrate significant variation in severity. Depending on the type of tear, location, muscle quality, and extent of retraction, management of the rotator cuff tear can also differ considerably from patient to patient. In cases where surgical management is indicated, the surgeon has many options, including debridement, arthroscopic repair, mini-open repair, and open repair. At times, surgery may be performed in combination with other procedures, such as a total shoulder arthroplasty. In this chapter, we will describe the surgical management of a massive subscapularis tendon tear, including a subcoracoid decompression. The preparation, technique, and rehabilitation for this unique surgical case will be described in detail and demonstrated through a video presentation.