Rotator cuff tears include a variety of tear sizes, tear locations, and associated pathology. Patients may present with a spectrum of findings from no pain to severe shoulder pain and normal function to severe dysfunction. Recent biomechanical and clinical research has improved our understanding of the complexity of rotator cuff tears, including risk factors associated with certain tear patterns and tear progression as well as the biomechanical consequences of rotator cuff tears. Specifically, studies investigating risk factors of rotator cuff tears have demonstrated the importance of factors such as age, muscle quality, and tear size on long-term patient outcomes. By understanding risk factors associated with symptoms of rotator cuff tears and tear progression, indications for surgical management can be refined to improve patient selection and ultimately patient outcomes.