Execution
- 1Expose the posterior shoulder girdle and observe the scapula, clavicle, humerus, and thoracic posture from behind and slightly lateral to the patient.
- 2Ask the patient to elevate both arms through abduction, then through forward flexion or scaption, while comparing the symptomatic and asymptomatic sides.
- 3Watch the ascending and descending phases for coordinated humeral elevation, scapular upward rotation, posterior tilt, clavicular elevation / rotation, and smooth return.
- 4Note shrugging, early upper-trapezius dominance, scapular winging, excessive protraction, hitching, jumping, or reverse scapulohumeral rhythm.
- 5Repeat elevation with a light external load if the abnormal rhythm is subtle and symptoms allow loaded testing.
Positive outcome
Abnormal findings include asymmetrical or poorly coordinated scapular and humeral motion, scapular winging, early or excessive scapular elevation, hitching or jumping during descent, or reverse scapulohumeral rhythm. Magee notes that dyscontrol is often more visible during lowering than during elevation. A shrug sign indicates inability to elevate the arm without excessive scapular elevation and may be seen with adhesive capsulitis, large rotator cuff tear, or glenohumeral arthritis.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Ludewig & Reynolds (2009) | NA | NA | NA | NA | NA |
| Wassinger et al. (2015) | poor-fair | 35 | 60 | 0.87 | 1.09 |
CommentMovement-quality screen, not a diagnostic test for one shoulder pathology. Wassinger 2015 directly tested visual scapulohumeral movement evaluation against clinical shoulder impairment classification (33 raters, 12 patients) and found poor diagnostic accuracy: Sn 35, Sp 60, LR+ 0.87, LR− 1.09 — confidence interval crosses 1.0, so the test does not meaningfully shift post-test probability. Use it to identify the comparable sign and guide follow-up tests (SDT, SAT, SRT, cuff strength), not as a diagnostic decision-maker.
Low Clinical Value