Shoulder Orthopaedic Test: Lag Sign of the Shoulder

The Lag Sign of the Shoulder is a clinical test used to assess the presence of a full-thickness rotator cuff tear. During the test, the patient's arm is passively moved into shoulder abduction and external rotation, and the examiner asks the patient to maintain this position against resistance. If the patient is unable to hold the arm in this position and experiences pain, this suggests a full-thickness rotator cuff tear.

Here are the steps to perform the Lag Sign of the Shoulder test:

1. The patient is seated with the arm of the affected shoulder abducted to 90 degrees and externally rotated.
2. The examiner supports the patient's elbow and wrist and lifts the arm to a point just short of the patient's pain threshold.
3. The examiner instructs the patient to maintain the position actively while the examiner releases support of the patient's wrist.
4. The patient is asked to hold this position for as long as possible.
5. If the patient is unable to maintain the position or experiences pain, this is considered a positive test result and indicates the presence of a full-thickness rotator cuff tear.

References:

1. Park HB, Yokota A, Gill HS, et al. Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg Am. 2005;87(7):1446-1455.
2. Kim HJ, Kim JY, Park JS, et al. Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. J Korean Med Sci. 2010;25(5):817-822.
3. Hegedus EJ, Goode AP, Cook CE, et al. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med. 2012;46(14):964-978.
4. O'Connor FG, Steinberg LH. Shoulder injuries. In: Bracker MD, ed. Primary Care Sports Medicine. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007:339-351.