The management of rotator cuff tears has evolved significantly with advances in the understanding of natural history, as well as treatment options and surgical techniques for repair, augmentation, and replacement. It is important to provide a comprehensive overview of current treatment options for rotator cuff tears, emphasizing the importance of individualized decision making based on tear characteristics, tissue quality, and functional goals. Nonsurgical treatment remains a viable first-line approach for many degenerative tears. Arthroscopic repair should be performed when repairable. When not repairable, pain-reducing procedures such as isolated biceps management, subacromial balloon, and tuberoplasty should be considered. Tendon transfers, patch augmentation, superior capsule reconstruction, and reverse shoulder arthroplasty are options that can help improve function. A thorough understanding of the indications, limitations, and expected outcomes of each modality is essential.