Among those conditions causing shoulder pain, rotator cuff disease is the most common pathology; the prevalence of full-thickness rotator cuff tears in the elderly population ranges from 5% to 40%. Because rotator cuff surgical treatment is such an important and common procedure, it surprising that the surgical indications remain nonstandardized and controversial.1,2 Surgical indications, at a fundamental level, involve a comparison of the relative risks and benefits of two different treatment alternatives. In the case of rotator cuff repair, we are dealing primarily with the risks of operative cuff repair versus nonoperative measures. The risks and benefits of both nonoperative and operative treatment have to be considered in order to fully consider treatment indications. Although the benefits of successful operative and nonoperative treatment are well known, the risks of conservative treatment are less apparent but also important to consider.