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The Drop Arm & Hornblower Test for Rotator cuff tears

The thing about rotator cuff tears is that they don’t have to necessarily get healed for the symptoms to disappear, they may just enlarge or stabilize in size. Most often in the case of rotator cuff tears there may not even be any shoulder pain. There are about 25 different functional diagnostic tests that can be applied to either directly prove a rotator cuff injury or these tests could help to rule out similar injuries like nerve impingement or torn labrum.

Two such commonly employed shoulder tests to diagnose a torn rotator cuff is the Drop Arm Test and the Hornblower Test. More than pain in the shoulder joint, it is significant weakness on the affected side that could be a strong indicator of rotator cuff tears. Along with these tests imaging tests like an MRI could help confirm the diagnosis. Let’s look at these tests in detail.

One of the easiest methods to determine a torn rotator cuff is certainly the Drop Arm Test. This can be especially useful to assess for full thickness rotator cuff tears of the supraspinatus and infraspinatus, and also to diagnose sub-acromial pain syndrome which is shoulder impingement. The test can help differentiate between shoulder and rotator cuff pathologies.

In order to perform the Drop Arm Test, the patient will be required to hold their arm out to the side at a 90-degree angle with the thumb pointing down. The arm will then be needed to lowered down slowly towards the ground. As the name suggests, if the arm drops suddenly, there is a likelihood of a rotator cuff tear.

The inability to hold the arms at 90 degrees because of pain or weakness is seen as a positive result of for the test.  The Drop Arm Test can be more accurate when used along with a combination of other tests like the Empty/full can test, External rotation lag sign, Internal rotation lag sign and the Hornblower’s sign. Doing a battery of tests will help to differentiate between rotator cuff muscles and will give a more accurate diagnosis.

The Hornblower’s Test that is also knows as Hornblower’s Sign or the Patte Test is another common special test used to physically assess and examine the shoulder. This is a very reliable test that can check the integrity of the muscles of the rotator cuff. The structures involved while performing this test are the teres minor muscle, teres minor tendon, infraspinatus muscle and the infraspinatus tendon.

The Hornblower’s Test has been proven to be an accurate and reliable test of teres minor integrity. This test can be performed while the patient is sitting or standing. The arm that is to be tested is elevated to 90 degrees of shoulder abduction in the scapular plane. The elbow will be in 90 degrees of flexion and is externally rotated. The doctor will then apply an internal rotation force to the forearm or wrist. The patient will be required to resist movement while attempting to externally rotate the shoulder.

If a weakness is experienced and if there is a marked inability to externally rotate then the test result is seen as positive. As the name Hornblower’s Sign suggests when the patient cannot hold the arm up with the hand to the mouth as if blowing a horn, then this could signify some damage to the teres minor rotator cuff muscle.

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