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Drop Arm Test

 Drop Arm Test


Drop Arm Test is used to check for the integrity of the supraspinatus muscle of the rotator cuff of the shoulder. It’s sometimes called Codman’s test.

The drop arm test determines the patient’s ability to control humeral motion via an eccentric contraction as the arm is slowly lowered from full abduction to adduction.

How do you perform the Drop Arm Test?

  • The patient is sitting or standing with his or her back to the examiner.
  • The affected arm is held at 90 degrees of elevation in the scapular plane and at almost full external rotation with the elbow flexed at 90 degrees.
  • The patient is asked to maintain this position actively as the examiner releases the wrist while supporting the elbow, which is mainly a function of the infraspinatus.
Drop Arm Test
Drop Arm Test

What does a positive Drop Arm Test mean?

Weakness in maintaining the position of the arm , with or without pain, or sudden dropping of the arm suggests a rotator cuff lesion, most often this is due to a defect in the supraspinatus muscle.

Sensitivity & Specificity

A literature review 1 in MEDLINE was performed for physical examination tests/maneuvers of the rotator cuff tears, and found that drop arm sign has the following accuracy:

  • Sensitivity: 73 %
  • Specificity: 98 %

Another study by Walch G 2 found that this test has a 100% sensitivity and a 100% specificity for irreparable degeneration of the infraspinatus muscle (confirmed at the time of surgery), although the test was performed with the arm at the patient’s side, which is not the original description.

The clinical usefulness of the drop arm test in improved when the results are combined with the findings of other tests. A positive drop arm sign with an associated painful arch and a weak infraspinatus manual muscle test (MMT) increase the probability of a full thickness rotator cuff tear to 91%.

Diagnostic Utility of the Drop Arm Test in Identifying Subacromial Impingement:

Description and Positive
Findings
PopulationReference StandardSensSpec+LR-LR
The patient fully elevates the arm and then slowly reverses the motion in the same arc. If the arm is dropped suddenly or the patient has severe pain, the test is considered to be positivePooled estimates from five studies (n = 1213)Impingement syndrome diagnosed by arthroscopy.21 (.14, .30).92 (.86, .96)2.6.86
Patient is instructed to abduct shoulder to 90 degrees and then lower it slowly to neutral position. Positive if patient is unable to do this because of pain125 painful shouldersSubacromial impingement diagnosed via subacromial injection.08.972.67.95

Notes

If the patient is able to lower the arm in a controlled manner through the ROM, a derivative of the drop arm test may be implemented: The patient holds the humerus in 90° abduction. The examiner applies gentle pressure on the distal forearm. A positive test result causes the arm to fall against the side of the body, indicating lesions to the rotator cuff.

A positive drop arm test may also have neurologic causes, such as damage to the subscapular nerve, so the patient must be thoroughly examined from a neurologic standpoint.

In lesions of the supraspinatus muscle as a result of chronic degenerative processes, the drop arm test may be falsely negative due to muscular compensation, especially by the deltoid muscle.

Related Anatomy

Supraspinatus Muscle:

  • Supraspinatus muscle originates from Superior scapula and inserts onto Greater tuberosity of the humerus.
  • Its action includes Abducting and externally rotating arm, providing stability to the shoulder joint.
  • It’s innervated by the Suprascapular nerve.

Reference

  1. 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. Author manuscript; available in PMC 2014 Jan 1. PMID: 23332909.
  2. Walch G, Boulahia A, Calderone S, Robinson AH. The ‘dropping’ and ‘hornblower’s’ signs in evaluation of rotator-cuff tears. J Bone Joint Surg Br. 1998 Jul;80(4):624-8. doi: 10.1302/0301-620x.80b4.8651. PMID: 9699824.
  3. Miller CA, Forrester GA, Lewis JS: The validity of the lag signs in diagnosing full-thickness tears of the rotator cuff: a preliminary investigation. Arch Phys Med Rehabil. 2008 Jun; 89(6):1162-8. PMID: 18503815.
  4. Park HB, Yokota A, Gill HS, El Rassi G, McFarland EG: Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg Am. 2005 Jul; 87(7):1446-55. PMID: 15995110.
  5. Yuen CK, Mok KL, Kan PG: The validity of 9 physical tests for full-thickness rotator cuff tears after primary anterior shoulder dislocation in ED patients. The American journal of emergency medicine. 2012 Feb 29. PMID: 22386341.
  6. Murrell GA, Walton JR. Diagnosis of rotator cuff tears. Lancet. 2001 Mar 10;357(9258):769–770. PMID: 11253973.
  7. van Kampen DA, van den Berg T, van der Woude HJ, Castelein RM, Scholtes VA, Terwee CB, Willems WJ. The diagnostic value of the combination of patient characteristics, history, and clinical shoulder tests for the diagnosis of rotator cuff tear. J Orthop Surg Res. 2014 Aug 7;9:70. doi: 10.1186/s13018-014-0070-y. PMID: 25099359; PMCID: PMC4237868.
  8. Alqunaee M, Galvin R, Fahey T. Diagnostic accuracy of clinical tests for subacromial impingement syndrome: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2012;93(2):229-236.
  9. Silva L, Andreu JL, Munoz P, et al. Accuracy of physical examination in subacromial impingement syndrome. Rheumatology (Oxford). 2008;47:679-683.
  10. Campbel’s Operative Orthopaedics 13th Edition Book.
  11. Clinical Tests for the Musculoskeletal System 3rd Edition.
  12. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.

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