The clinical presentation of rotator cuff ruptures varies greatly and ranges from no symptoms to severe shoulder impairment. Clinical shoulder tests are an effective screening tool to identify patients who require early specialist assessment or further radiological investigation, but they are not sufficient to rule out smaller ruptures. Small ruptures can often be managed non-surgically, while larger traumatic ruptures may necessitate early surgical intervention. Treatment is multimodal, requires a thorough clinical evaluation, and should be individualized through shared decision-making as discussed in this review.