Synopsis The hallmark characteristics of rotator cuff (RC) tendinopathy are pain and weakness experienced most commonly during shoulder external rotation and elevation. Assessment is complicated by non-specific clinical tests and the poor correlation between structural failure and symptoms. As such, diagnosis is best reached by exclusion of other potential sources of symptoms. Symptomatic incidence and prevalence data currently cannot be determined with confidence, primarily as a consequence of a lack of diagnostic accuracy, as well as the uncertainty as to the location of symptoms. People with symptoms of RC tendinopathy should derive considerable comfort from research that consistently demonstrates improvement in symptoms with a well-structured and graduated exercise program and that this improvement is equivalent to outcomes reported in surgical trials; with the additional generalised benefits of exercise, less sick leave, a faster return to work, and reduce costs to the healthcare system. This evidence covers the spectrum of conditions that include symptomatic RC tendinopathy, and atraumatic partial and full thickness RC tears. The principles guiding exercise treatment for RC tendinopathy include: relative rest, modification of painful activities, an exercise strategy that initially does not exacerbate pain, controlled reloading, and gradual progression from simple to complex shoulder movements. Evidence also exists for a specific exercise program being beneficial for people with massive inoperable tears of the RC. Education is an essential component of rehabilitation and attention to lifestyle factors (smoking cessation, nutrition, stress, and sleep management) may enhance outcome. Outcomes may also be enhanced by sub-grouping RC tendinopathy presentations and directing treatment strategies according to the clinical presentation. There are substantial deficits in our knowledge regarding RC tendinopathy that need to be addressed to further improve clinical outcomes. J Orthop Sports Phys Ther, Epub 21 Sep 2015. doi:10.2519/jospt.2015.5941