Zmistowski B, et al. - All reverse total shoulder arthroplasty (RTSA) done at a single tertiary referral hospital were retrospectively analyzed in order to examine the incidence and predictors of acromial stress fractures (ASFs) after RTSA. Between September 2010 and January 2017, with at least 3 months' clinical follow-up in 958 cases, a total of 1,170 RTSAs were done. There were 40 ASFs and 61 acromial stress reactions. Female gender, reduced variation in deltoid length, and raised preoperative glenohumeral center-of-rotation medialization were the independent predictors of acromial stress pathology. Therefore, after RTSA, acromion-related symptoms are common. Female individuals with progressed preoperative center-of-rotation medialization had an improved incidence of ASFs. However, this study authenticates which individuals are at risk of ASFs, techniques for prevention of ASFs is yet to be cleared.