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Background. As Americans become more active and live longer we subject ourselves to an increased risk of overuse and traumatic injuries. High prevalence of injuries occur to the most mobile joint in the human body, the shoulder girdle. One of the most frequent injury types of the shoulder is damage or tearing of the rotator cuff musculature. Many treatment options are available for the management of rotator cuff tears ranging from conservative therapy based treatment to open surgical intervention, yet no modality has clearly demonstrated superiority. Objective. To determine if surgery or conservative treatment provide better long-term outcomes for patients with a rotator cuff tear. Methods. An evidence-based medicine literature review study design was performed to search UpToDate, PubMed and Google Scholar. for articles pertaining to answering the research question. The specific limits were last 10 years, human, English, full text, systematic review and meta-analysis. Application of the inclusion and exclusion criteria was utilized to further extract the most relevant articles. Following this the Oxford Centre for EvidenceBased Medicine (2009) guidelines were used to determine levels of evidence along with the critical appraisal skills program to assess for bias. Results. Following applications of the methods above, three articles were included for data extraction to answer the research question. The first article was a IIIA level of evidence systematic review of 137 previous studies which resulted in limited, indeterminate findings without any statistical or clinical significance for either treatment option. The second study, with a IB level of evidence, is a multi-populational meta-analysis of two hundred fifty-two participantsthat illustrated limited, non-significant evidence for surgical treatment. The third article, a level II meta-analysis of two hundred sixty-nine participants with rotator cuff injury, showed statistical significance only for surgery without any evidence of clinical significance. Conclusion. This research yielded limited, inconclusive low-strength evidence CONSERVATIVE VS. SURGICAL OUTCOMES iv that shows a slight inclination to surgical management in the acute injury phase. Due to the low strength of evidence, no clear or concrete recommendations can be made. More importantly, this research has demonstrated the need for highly specific and stronger evidence-based studies that addressthe many limitations associated with rotator cuff management.