Shoulder Orthopaedic Test: Codman's Test

Codman’s Test is commonly used to assess whether the client can control lowering the arm from an elevated position. A positive finding may include sudden dropping, inability to lower smoothly, marked weakness or familiar pain. Contemporary shoulder assessment commentary cautions that rotator cuff special tests do not isolate single structures and should be interpreted with strength testing, ROM, history and functional findings.  

Introduction

A client reports shoulder pain and weakness when lowering the arm from overhead, reaching to the side or controlling the arm after lifting. They may be able to raise the arm with assistance but struggle to lower it smoothly.

Codman’s Test helps assess whether the client can control the arm during lowering. The finding should be described precisely: pain, weakness, drop, compensation or inability to control the movement.

Quick Summary

Test name: Codman Test
Also known as: Drop Arm Test in many clinical contexts
Body region: Shoulder, rotator cuff
Purpose: Assess ability to control arm lowering from an elevated position
Positive finding: Arm drops suddenly, cannot be lowered smoothly, marked weakness or familiar pain
Negative finding: Smooth controlled lowering without meaningful pain or weakness
Best used with: Empty Can, Full Can, External Rotation Lag Sign, Drop Arm, shoulder ROM and strength testing
Key limitation: It does not isolate one rotator cuff tendon or diagnose a tear on its own

What Is the Codman Test?

Codman’s Test is a shoulder control and rotator cuff-related special test. The professional raises the client’s arm into elevation or abduction, then asks the client to slowly lower it.

Difficulty lowering the arm smoothly may suggest significant weakness, pain inhibition or rotator cuff-related involvement.

Why It Is Used

The test is used when rotator cuff involvement is part of the clinical reasoning, especially when the client reports difficulty controlling the arm from an elevated position.

It may help assess functional weakness and pain during arm lowering.

What It Assesses

The test assesses active control of shoulder lowering from elevation. It may reflect rotator cuff function, deltoid contribution, pain inhibition, apprehension, stiffness or motor control.

It does not isolate the supraspinatus or confirm a rotator cuff tear.

Who It Is Useful For

This test may be useful for clients with shoulder pain, weakness, difficulty lowering the arm, suspected rotator cuff involvement, older adults with sudden weakness or clients with overhead activity limitations.

When to Use This Test

Use when the client can safely have the arm placed into elevation and the test does not provoke severe symptoms.

When Not to Use or When to Be Cautious

Use caution with acute trauma, suspected fracture, recent dislocation, severe pain, recent surgery, inability to tolerate arm elevation or neurological symptoms.

Equipment Required

Chair or standing space
Pain and strength scale
Measurz recording workflow
Optional comparison side notes

Step-by-Step Protocol / Practice

Setup

Position the client sitting or standing.

Client position

The client keeps the trunk upright and the arm relaxed.

Examiner position

Stand beside the tested shoulder.

Hand placement

Support the arm and gently lift it into the selected elevated or abducted position.

Stabilisation

Monitor trunk lean, shoulder shrugging and scapular compensation.

Movement or force direction

Ask the client to slowly lower the arm under control.

Instructions

Ask the client to report pain, weakness, catching, giving way or familiar symptoms.

Positive finding

A positive finding is sudden arm drop, inability to lower smoothly, marked weakness or familiar pain.

Negative finding

A negative finding is smooth controlled lowering without meaningful pain or weakness.

Stopping criteria

Stop if pain increases sharply, the arm drops unexpectedly, the client cannot control the arm or the position is not tolerated.

Safety notes

Be ready to support the arm if it drops.

Positive and Negative Test Interpretation

For the Codman Test, also commonly called the Drop Arm Test, there is newer peer-reviewed evidence from Park et al. (2005). This study assessed several shoulder tests, including the drop-arm sign, and reported that diagnostic values varied considerably across tests. The best test cluster for full-thickness rotator cuff tears included the painful arc sign, drop-arm sign, and infraspinatus muscle test, with a post-test probability of 91% when all three were positive.  

The 2017 systematic review by Gismervik et al. also notes that prior meta-analysis evidence found tests such as Hawkins, supraspinatus, drop arm, and lift-off had limited diagnostic validity overall, and that single shoulder tests generally perform best when interpreted in context rather than alone.  

Sensitivity, Specificity and Diagnostic Accuracy

High-quality 2020+ diagnostic accuracy values for Codman’s Test alone were not identified. Contemporary clinical commentary cautions against assuming shoulder special tests isolate a single rotator cuff structure.  

Older diagnostic accuracy values for the Drop Arm Test exist, but because your instruction was to use references from 2020 and above, those older values are not listed here.

Reliability and Validity

Reliability depends on starting arm position, speed of lowering, symptom criteria, examiner support, client effort and whether the result is recorded as pain, weakness or dropping.

Because the test depends heavily on pain and motor control, it should be paired with other rotator cuff and strength measures.

Common Errors and Limitations

Common errors include not supporting the arm, moving too fast, interpreting pain alone as a tear, not recording starting angle, failing to compare sides and treating the test as structurally specific.

Limitations include pain inhibition, deltoid contribution, guarding, stiffness, neurological weakness and limited stand-alone diagnostic accuracy evidence.

Practical Applications

Use Codman’s Test to document whether the client can control arm lowering from elevation. It may help guide strength testing, referral reasoning or exercise modification when marked weakness is present.

How to Record This in Measurz

Record test name, side tested, result, starting arm angle, plane of movement, pain score, symptom location, weakness, drop/no drop, movement quality, compensation, comparison side, confidence in result and reason for stopping.

Add related findings such as Empty Can, Full Can, external rotation strength, lag signs, shoulder ROM and functional overhead tasks.

Related Tests / Internal Links

Empty Can Test
Full Can Test
Drop Arm Test
External Rotation Lag Sign
Infraspinatus Test
Shoulder ROM Tests
Shoulder Strength Testing
Painful Arc

FAQs

What does the Codman Test assess?

It assesses whether the client can control lowering the arm from an elevated position.

What is a positive Codman Test?

A positive finding is sudden dropping, inability to lower smoothly, marked weakness or familiar pain.

Can it diagnose a rotator cuff tear?

No. It may support suspicion but does not diagnose a tear on its own.

Is pain alone enough for a positive test?

Pain should be recorded, but weakness and loss of control provide different information.

What should be recorded?

Record side, starting angle, pain, weakness, drop/no drop, movement quality and comparison side.

Key Takeaways

Codman’s Test assesses arm-lowering control.
A positive result may reflect pain inhibition, weakness or rotator cuff involvement.
It does not isolate one tendon or diagnose a tear.
The starting angle and movement quality should be recorded.
Measurz should capture pain, weakness, drop and compensation.

References

Park, H. B., Yokota, A., Gill, H. S., El Rassi, G., & McFarland, E. G. (2005). Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. The Journal of Bone and Joint Surgery. American Volume, 87(7), 1446–1455. https://doi.org/10.2106/JBJS.D.02335 

Powell, J. K., & Lewis, J. S. (2020). It is time to put special tests for rotator cuff-related shoulder pain out to pasture. Journal of Orthopaedic & Sports Physical Therapy, 50(5), 222–225.

Gismervik, S. Ø., Drogset, J. O., Granviken, F., Rø, M., & Leivseth, G. (2017). Physical examination tests of the shoulder: A systematic review and meta-analysis of diagnostic test performance. BMC Musculoskeletal Disorders, 18, 41. https://doi.org/10.1186/s12891-017-1400-0