External Rotation Lag Sign

 External Rotation Lag Sign

What is External Rotation Lag Sign?

How it’s Performed?

What does a positive External Rotation Lag Sign mean?

Sensitivity & Specificity

A comparative study by Filippo Castoldi1 to reassessed the sensitivity and the specificity of the external rotator lag sign (ERLS) for diagnosis of supraspinatus tears in a large cohort of patients. He found that the External Rotation Lag Sign is highly specific and acceptably sensitive for diagnosis of full-thickness tears of the rotator cuff, even in case of an isolated tear of the supraspinatus tendon:

Another study by Hertel et al.2 reported 70% Sensitivity and 100% Specificity with this test , but the study had a
potential for bias.


Related Anatomy

Supraspinatus Muscle:

Infraspinatus Muscle:

Rotator Cuff muscles
Rotator Cuff muscles


  1. Filippo Castoldi, Davide Blonna, Ralph Hertel: External rotation lag sign revisited: accuracy for diagnosis of full thickness supraspinatus tear. J Shoulder Elbow Surg . Jul-Aug 2009;18(4):529-34. PMID: 19223205.
  2. Hertel R, Ballmer FT, Lombert SM, et al: Lag signs in the diagnosis of rotator cuff rupture. J Elbow Shoulder Surg Am 5:307–313, 1996.
  3. Blonna D, Cecchetti S, Tellini A, et al. Contribution of the supraspinatus to the external rotator lag sign: kinemtic and electromyographic pattern in an in vivo model. J Shoulder Elbow Surg 2010;19(3):392–398. PMID: 20056454.
  4. Clinical Tests for the Musculoskeletal System 3rd Edition.
  5. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.

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