August 2015

Hornblower’s Sign

The evaluation of the Rotator Cuff is largely done by history, physical examination, and radiographic studies. As with all parts of the body, certain signs have been observed and physical examination test described which have a level of predictability in making an accurate diagnosis. Following this, more extensive workup may assist in coming to a final diagnosis.

External rotators of the shoulder include the posterior deltoid, the infraspinatus, and the teres minor. The infraspinatus and the teres minor together contribute to more than 80% of the external rotation torque while the teres minor alone contributes up to 45%.

Evaluation of the rotator cuff maybe performed with several specific tests, and each of the tendons can be somewhat isolated on certain test. The supraspinatus can be evaluated with the Jobe test, the subscapularis with the Lift Off test, the infraspinatus with the Lag Sign, and the teres minor with the Hornblower’s sign.

The Hornblower’s sign occurs when the patient is unable to externally rotate the arm with the shoulder elevated 900 from the body in the scapular plane. In severe cases this can be seen when asking the patient to bring the hand to the mouth. If one is unable to externally rotate the arm then one must elevate the shoulder to 900and extend the wrist to get the hand to the mouth. This is significant information in that these patients may have a large/massive rotator cuff tear. This correlates to a high probability of atrophy and fatty infiltration of the cuff musculature, and thus surgical repair outcome is often poor.


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Jain NB, Wilcox R, Higgins LD. Clinical Examination of the Rotator Cuff. Web <>

Tennent TD, Beach WR, Meyers JF. The Review of the Special Test Associated with Shoulder Examination Part I: The Rotator Cuff Tests. Am J Sports Med. 2003; 31: 154-160.

Scheibel M, Magosch P, Pritsch M, Lichtenberg S, Habermeyer P. The Bell-Off Sign: A New Clinical Diagnostic Sign for Subscapularis Lesions. Arthroscopy. 2005; 21: 1229-1235.

Submitted by:
Ricardo Rodriguez, MD
Baton Rouge, LA