Rotator cuff tears (RCT) are one of the most commonly treated orthopaedic pathologies, yet controversy exists regarding the management of these injuries. Irreparable rotator cuff tears are unpredictable with respect to their clinical presentation. The spectrum of pain and functional disability varies widely. Rehabilitation protocol is always the first solution in treating irreparable cuff tears, but non-functional and painful shoulders (e.g., arthrosis) is an indication for surgery. Can we ask ourselves a question: where lies the limit of trying “persistent” surgical repair of massive irreparable RC lesions? There is a lack of high-quality comparative studies to guide treatment recommendations. Physical therapy compared to surgery is associated with a lower improvement in perceived functional outcome and higher clinical failure rate. However, there is insufficient evidence to establish an evidence-based treatment algorithm for MRCTs. Treatment is based on patient factors and associated pathology and includes personal experience and data from case series. It has to be underlined that the winner is always team physiotherapist/surgeon, and their cooperation is crucial at all stages of therapy