There is substantial evidence that shows that rotator cuff degeneration is part of the normal aging process. Every decade of life after the age of 50 we see a dramatic increase in the percentage of folks who develop rotator cuff tears. It is estimated that 25-30% of folks age 50-60 will develop a rotator cuff tear. Furthermore, the incidence of rotator cuff tear in folks age 60–70 is nearly 35-40%. We attributed this to a tenuous blood supply coupled with the significant demand and forces generated by the rotator cuff. These tendons work in concert to allow folks the tremendous range of motion that we have in the shoulder. It is interesting that many folks may have a tear but it remains asymptomatic. There is significant controversy over what exactly causes a rotator cuff tear to begin to cause pain. It is interesting to note that rotator cuff tears do not have much ability to heal if it is a complete tear. Folk’s will often described an aching pain, which is worse at night, and it may be coupled with weakness with overhead activity. If the symptoms have persisted despite conservative treatments including physical therapy surgery may be recommended.