The examiner brings the shoulder to 90 degrees of abduction and 90 degrees of external rotation.
Then he asks the patient to hold this position.
What does a positive Hornblower sign mean?
It considered Positive if the patient arm falls into internal rotation.
Sensitivity & Specificity
A study by G Walch1 on 54 patients operated on for combined supraspinatus and infraspinatus rotator-cuff tears, the Hornblower sign’s Sensitivity & Specificity were as following:
Sensitivity: 100 %
Specificity: 93 %
A second way to do the test is to ask the patient to standing with the arms by the side and then to bring the hands to the mouth. With a massive posterior rotator cuff tear, the patient is unable to do this without abducting the arm first. This abduction with hands to the mouth is called Hornblower’s sign.
Humerus (medial ITG)
Adducting, internally rotating, extending arm
Providing stability, externally rotating arm
Lower subscapular nerve
Walch G, Boulahia A, Calderone S, Robinson AH. The dropping and Hornblower’s signs in evaluating rotator cuff tears. J Bone Joint Surg (Br). 1998;80:624–8. PMID: 9699824.
Nitin B. Jain, MD, MSPH, Reginald Wilcox, PT, Jeffrey N. Katz, MD, MS, and Laurence D. Higgins, MD. Clinical Examination of the Rotator Cuff. PM R. 2013 Jan; 5(1): 10.1016/j.pmrj.2012.08.019. PMID: 23332909.
Clinical Tests for the Musculoskeletal System, Third Edition book.
Mark Dutton, Pt . Dutton’s Orthopaedic Examination, Evaluation, And Intervention, 3rd Edition Book.