The indications for surgery depend much on the degree of the tear. If it’s a full thickness tear in someone who’s very active and if it’s their dominant shoulder, then I would tend to suggest surgery for that. If it’s a 65 year old man who plays tennis on the weekends and he can’t get his arm up over his head and he has a full thickness rotator cuff tear, it’s very unlikely that a course of physical therapy is going to address his problem. For a patient like that, I would generally suggest repairing the rotator cuff because that will allow him to get his arm up over his head and do basic activities of daily living and hopefully allow them to get back to activities that he enjoys. For partial thickness tears, generally I will suggest starting with conservative management – with a physical therapy, perhaps a cortisone injection, and activity modification to avoid excessive overhead activities to prevent aggravating the condition.