Rotator cuff tears and subacromial impingement are second only to acromioclavicular joint disorders as the most common causes of shoulder pain. Although most orthopedic surgeons are willing to initially treat shoulder impingement syndrome conservatively, they are reluctant to manage rotator cuff tears-especially full-thickness tears-nonoperatively. The purpose of this article is to explain the biomechanical rationale of nonoperative treatment, review the literature pertaining to nonoperative treatment of full-thickness rotator cuff tears, and describe a nonoperative treatment program.