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Special tests for the infraspinatus and teres minor

This is an excerpt from Pocket Atlas of Special Tests for the Upper Limb, The by Jane C. Johnson.

Infraspinatus and teres minor originate on the posterior surface of the scapula and insert onto the head of the humerus (figure 5.1). Both muscles bring about adduction, and their primary action is lateral rotation of the glenohumeral joint. Therefore, an inability to hold the arm in a position of abduction and lateral rotation or difficulty performing a concentric or isometric contraction of the muscles indicates a problem.

This chapter provides information about three tests in which the client is required to hold their arm in abduction and external rotation (External Rotation Lag Sign, Hertel’s Drop Sign, Walch’s Hornblower Sign), one test that requires the client to perform concentric contraction of the muscles (Patte’s Test), and one that requires isometric muscle contraction (Internal Rotation Resistance Strength Test). As the name implies, the Internal Rotation Resistance Strength Test, also tests internal rotation.

External Rotation Lag Sign

Purpose: Described by Hertel et al. (1996), along with the Internal Rotation Lag Sign and (Hertel’s) Drop Sign, this tests for rupture predominantly of the infraspinatus and supraspinatus tendons. It has been included here as it specifically requires active contraction of infraspinatus.

Type of Test: This is a test of strength in the lateral rotators of the humerus.

Procedure: With the client’s arm by their side, the elbow flexed to approximately 90°, passively elevate the shoulder to about 20° in the scapular plane. Holding the client’s forearm at the wrist and elbow, passively place the arm into full external rotation minus 5° (figure 5.2a). Maintaining your support of their elbow, ask your client to maintain this position when you remove your support of their wrist.

Findings: The test is positive if the client cannot retain the position and the arm drifts inward (figure 5.2b). The amount of “lag” can be measured in degrees.

Tip: It is important not to position the arm into full external rotation at the start of the test to minimize the naturally occurring elastic recoil of the joint.

Hertel’s Drop Sign

Purpose: Described by Hertel et al. (1996), along with the External Rotation Lag Sign and Internal Rotation Lag Sign, this tests for lesions of the infraspinatus. Note that this is different to the Drop Test described by Codman (1934).

Type of Test: This is a test of strength for infraspinatus.

Procedure: With your client’s elbow flexed, passively elevate the shoulder to 90°, and almost fully externally rotate the arm with the elbow flexed to 90° (figure 5.3a). Maintaining support of the elbow, ask the client to maintain this position whilst you release their wrist.

Findings: The test is positive if the client is unable to maintain the position (figure 5.3b).

More Excerpts From Pocket Atlas of Special Tests for the Upper Limb, The

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