Execution
- 1Position the patient standing.
- 2Elevate the test arm to 90° in the scapular plane.
- 3Flex the elbow to 90°.
- 4Ask the patient to externally rotate the shoulder against resistance.
- 5Also ask the patient to bring the hand to the mouth and observe whether the patient must abduct the arm first.
Positive outcome
Inability to externally rotate the arm against resistance is positive. In the hand-to-mouth modification, the patient abducts the shoulder to bring the hand to the mouth, producing the classic hornblower posture. Magee states this indicates teres minor tear or major posterior cuff dysfunction.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Walch et al. (1998) | NA | 100 | 93 | 14.29 | 0.0 |
| Jain et al. (2017) | NA | 96 | 96 | 4.81 | NA |
| Collin et al. (2015) | NA | NA | NA | NA | NA |
CommentWalch's high LR+ comes from a selected surgical population with massive cuff tears and fatty degeneration, so the value should not be generalized to all shoulder pain. Jain's broader cohort still supports useful specificity, but with less dramatic likelihood ratios. Positive findings are clinically meaningful; negative findings do not fully exclude posterior cuff pathology.
High Clinical Value