The 'dropping' and 'hornblower's' signs in evaluation of rotator-cuff tears

Walch, Gilles; Boulahia, Aziz; Calderone, Salvatore; Robinson, A. H. N.

doi:10.1302/0301-620x.80b4.8651

Cited by 220 publications

(67 citation statements)

References 3 publications

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“…We agree with Tokish et al who found the subscapular muscle and tendon can be well tested with the press belly test [28] and with Walch et al who stated the teres minor muscle and tendon can be well evaluated with the hornblower' sign [21]. Our study also confirms the statement of Hertel et al who found clinical testing for lag signs to be efficient, reproducible, and reliable in evaluating the teres minor tendon and muscle [8].…”

Section: Discussionsupporting

confidence: 91%

What do standard radiography and clinical examination tell about the shoulder with cuff tear arthropathy?

Middernacht

Grave

Maele

et al. 2011

Journal of Orthopaedic Surgery and Research

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BackgroundThis study evaluates the preoperative conventional anteroposterior radiography and clinical testing in non-operated patients with cuff tear arthropathy. It analyses the radiological findings in relation to the status of the rotator cuff and clinical status as also the clinical testing in relation to the rotator cuff quality. The aim of the study is to define the usefulness of radiography and clinical examination in cuff tear arthropathy.MethodsThis study analyses the preoperative radiological (AP-view, (Artro-)CT-scan or MRI-scan) and clinical characteristics (Constant-Murley-score plus active and passive mobility testing) and the peroperative findings in a cohort of 307 patients. These patients were part of a multicenter, retrospective, consecutive study of the French Orthopaedic Society (SOFCOT-2006). All patients had no surgical antecedents and were all treated with prosthetic shoulder surgery for a painful irreparable cuff tear arthropathy (reverse-(84%) or hemi-(8%) or double cup-bipolar prosthesis (8%)).ResultsA positive significancy could be found for the relationship between clinical testing and the rotator cuff quality; between acromiohumeral distance and posterior rotator cuff quality; between femoralization and posterior rotator cuff quality.ConclusionA conventional antero-posterior radiograph can not provide any predictive information on the clinical status of the patient.The subscapular muscle can be well tested by the press belly test and the teres minor muscle can be well tested by the hornblower' sign and by the exorotation lag signs.The upward migration index and the presence of femoralization are good indicators for the evaluation of the posterior rotator cuff.An inferior coracoid tip positioning suggests rotator cuff disease.

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Section: Discussionsupporting

confidence: 91%

What do standard radiography and clinical examination tell about the shoulder with cuff tear arthropathy?

Middernacht

Grave

Maele

et al. 2011

Journal of Orthopaedic Surgery and Research

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“…Accuracy of the empty can test (sensitivity 86%), drop arm sign and external rotation lag signs (specificity 90–97%) was similar in this study compared with previous reports for rotator cuff integrity [16–18, 63, 64]. However, clinical tests previously reported to be diagnostic for subacromial “impingement” pathology including Hawkins-Kennedy test and painful arc in abduction [34] were of limited value for identifying SAP in the current study.…”

Section: Discussionsupporting

confidence: 83%

Diagnostic Accuracy of Clinical Examination and Imaging Findings for Identifying Subacromial Pain

et al. 2016

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BackgroundThe diagnosis of subacromial pathology is limited by the poor accuracy of clinical tests for specific pathologies. The aim of this study was to estimate the diagnostic accuracy of clinical examination and imaging features for identifying subacromial pain (SAP) defined by a positive response to diagnostic injection, and to evaluate the influence of imaging findings on the clinical diagnosis of SAP.Methods and FindingsIn a prospective, diagnostic accuracy design, 208 consecutive patients presenting to their primary healthcare practitioner for the first time with a new episode of shoulder pain were recruited. All participants underwent a standardized clinical examination, shoulder x-ray series and diagnostic ultrasound scan. Results were compared with the response to a diagnostic block of xylocaineTM injected into the SAB under ultrasound guidance using ≥80% post-injection reduction in pain intensity as the positive anaesthetic response (PAR) criterion. Diagnostic accuracy statistics were calculated for combinations of clinical and imaging variables demonstrating the highest likelihood of a PAR. A PAR was reported by 34% of participants. In participants with no loss of passive external rotation, combinations of three clinical variables (anterior shoulder pain, strain injury, absence of symptoms at end-range external rotation (in abduction)) demonstrated 100% specificity for a PAR when all three were positive (LR+ infinity; 95%CI 2.9, infinity). A full-thickness supraspinatus tear on ultrasound increased the likelihood of a PAR irrespective of age (specificity 98% (95%CI 94, 100); LR+ 6.2; 95% CI 1.5, 25.7)). Imaging did not improve the ability to rule-out a PAR.ConclusionCombinations of clinical examination findings and a full-thickness supraspinatus tear on ultrasound scan can help confirm, but not exclude, the presence of subacromial pain. Other imaging findings were of limited value for diagnosing SAP.

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“…A positive external rotation lag sign and a positive hornblower’s sign are indicative of posterior cuff deficits and external rotation inability [72, 73]. Moreover a positive hornblower’s sign has been associated with irreparable teres minor tears [73] and advanced fatty infiltration [7, 14] and is related to poor outcomes in tendon transfers [74]. This has been highlighted in the studies of Gerber et al .…”

Section: Indications-contraindication For Ld Transfermentioning

confidence: 99%

“…Reverse shoulder arthroplasty has been used with success in treating cuff tear arthropathies and restore active elevation [34-37]; it does not however restore active external rotation and may lead to reduced functional results [34, 123, 124]. Pseudoparalysis of external rotation has been mainly attributed to deficiency of the teres minor [72, 73, 125], relative to chronicity with ensuing atrophy or fatty infiltration [7, 126]. In this context, extending indications of LD tendon transfer to be performed in conjunction with reverse shoulder arthroplasty has provided a solution; as it has been demonstrated to increase external rotation and provide a better control of the arm in space [38-40].…”

Section: Reverse Shoulder Arthroplasty and Ld Transfermentioning

confidence: 99%

Latissimus Dorsi Transfer in Posterior Irreparable Rotator Cuff Tears

Anastasopoulos¹,

Alexiadis²,

Spyridonos³

et al. 2017

TOORTHJ

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Background:Massive rotator cuff tears pose a difficult and complex challenge even for the experienced surgeon; inability to repair these tears by conventional means designates them as irreparable, while management becomes quite taxing. Several operative options have been suggested for the management of such lesions with varying degrees of success, while it is imperative to match patient demands and expectations to the predicted outcome.Methods:Research articles are examined and key concepts are discussed, in order to provide an evidence based review of the available literature. The anatomy and pathomechanics along with the indications, contraindications and surgical techniques are reported.Results:Transfer of the Latissimus dorsi has been used with success to restore shoulder function in deficits of the posterior rotator cuff. Although it can be used in a variety of settings, the ideal patient for a Latissimus dorsi tendon transfer is a young and active individual, with no glenohumeral osteoarthritis that has a severe disability and weakness related to an irreparable posterior cuff tear.Conclusion:Tendon transfers have proved to be a successful treatment option in salvaging this difficult problem, providing pain relief and restoring shoulder function. Despite the excellent functional outcomes and pain suppression following operation, a variety of factors may affect the outcome; thus making indications and preoperative assessment a valuable component.

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The 'dropping' and 'hornblower's' signs in evaluation of rotator-cuff tears

Cited by 220 publications

References 3 publications

What do standard radiography and clinical examination tell about the shoulder with cuff tear arthropathy?

What do standard radiography and clinical examination tell about the shoulder with cuff tear arthropathy?

Diagnostic Accuracy of Clinical Examination and Imaging Findings for Identifying Subacromial Pain

Latissimus Dorsi Transfer in Posterior Irreparable Rotator Cuff Tears

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