Execution
- 1Position the patient standing or sitting and observe from the front and behind.
- 2Ask the patient to abduct or elevate the arm toward 90° without shrugging.
- 3Watch for elevation of the scapula or entire shoulder girdle before the humerus reaches 90°.
- 4Compare the movement with the opposite shoulder.
- 5Record whether shrugging reflects stiffness, weakness, pain inhibition, or poor scapulohumeral rhythm.
Positive outcome
The sign is positive when the patient cannot lift the arm to 90° without elevating or hiking the scapula / shoulder girdle. Magee associates this with adhesive capsulitis, large rotator cuff tears, and glenohumeral arthritis rather than frozen shoulder alone.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Jia et al. (2008) | NA | 95 | 50-53 | 2.03 | NA |
CommentThe shrug sign is sensitive for major shoulder movement limitation but nonspecific; it can occur with adhesive capsulitis, glenohumeral osteoarthritis, large cuff tears, or pain-inhibited elevation. Magee’s discussion places it within active elevation / scapulohumeral rhythm rather than as a frozen-shoulder-specific test. Use it to flag significant movement impairment, not to confirm adhesive capsulitis alone.
Moderate Clinical Value