The Upstream Rehabilitation Institute provides high-quality innovative post-professional education. This presentation is an example of providing education in an important and evolving subject area for the rehabilitation professional. Rotator cuff (RTC) pathologies are common diagnoses in physical therapy. The presentation will focus on the more difficult, non-progressing patient with rotator cuff involvement highlighting the natural history of progressive RTC pathology culminating in an irreparable tear and management. Attendees will review clinical pearls in evaluation and conservative management of cuff tears focusing on large and irreparable tears. Finally, an overview of surgical interventions will be discussed with emphasis on superior capsular reconstruction (SCR) and appropriate post-operative rehabilitation.