Active Elevation Lag Test

The Active Elevation Lag Test is a new clinical test to assess trapezius muscle function and potential spinal accessory nerve pathology. Spinal accessory nerve palsy causing trapezius dysfunction can lead to significant disability. Diagnosis is frequently delayed or inaccurate leading to inappropriate treatment.

How to Perform the Active Elevation Lag Test?

The execution of the Active Elevation Lag Test requires careful attention to detail and proper patient positioning. Begin by ensuring the patient is in a standing position with adequate space for arm movement. Prior to initiating the test, it’s imperative to confirm full passive range of motion, particularly in forward flexion, to rule out any mechanical restrictions that might affect the results.

Position yourself behind the patient and place one hand over their lumbar spine. This hand placement is crucial for detecting subtle changes in lumbar lordosis during the movement. Start the assessment with the unaffected side to establish a baseline for comparison. Direct the patient to perform forward flexion of the arm, achieving maximum possible elevation. During this movement, carefully monitor when the lumbar spine begins to extend, but allow the patient to continue to full elevation. Once maximum elevation is achieved, instruct the patient to gradually lower the arm to the point where the lumbar lordosis returns to its neutral position. Repeat this procedure on the affected side to compare the differences in elevation capability.

See Also: Trapezius Muscle Anatomy

What Constitutes a Positive Test?

A positive Active Elevation Lag Test manifests through several key indicators that suggest trapezius dysfunction or spinal accessory nerve pathology. The primary finding is an earlier onset of lumbar lordosis during forward flexion on the affected side compared to the unaffected side. This compensatory mechanism occurs as the body attempts to achieve elevation despite compromised trapezius function.

The active elevation lag test is quantified by measuring the difference in forward flexion capability between the affected and unaffected sides when the lumbar spine maintains normal lordosis. This measurement represents the functional deficit resulting from either direct trapezius muscle injury or compromise of its nerve supply through the spinal accessory nerve. The presence of a significant elevation lag indicates impaired force couple mechanics of the shoulder girdle, particularly affecting the trapezius muscle’s role in scapular rotation and elevation.

Reliability & Validity

Clinical studies have validated these findings through controlled trials, establishing the Active Elevation Lag Test as a reliable diagnostic tool in clinical practice. The test’s high positive predictive value of 95% and negative predictive value of 100% make it an invaluable component of the physical examination for suspected trapezius or spinal accessory nerve dysfunction.

References & More

1. Levy O, Relwani JG, Mullett H, Haddo O, Even T. The active elevation lag sign and the triangle sign: new clinical signs of trapezius palsy. J Shoulder Elbow Surg. 2009 Jul-Aug;18(4):573-6. doi: 10.1016/j.jse.2009.02.015. Epub 2009 May 7. PMID: 19423363. Pubmed
2. Orthopedic Physical Assessment by David J. Magee, 7th Edition.