Hornblower Sign

Hornblower sign (or as it called Patte Test) is used to test for Teres Minor or Infraspinatus muscle pathology of the rotator cuff (external rotators of the shoulder).

See Also: Rotator Cuff of the Shoulder

How do you do the Hornblower test?

• The patient is sitting or standing.
• 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?

Hornblower test is considered Positive if the patient’s arm falls into internal rotation indicating a tear of the Teres Minor muscle or Infraspinatus muscle.

Sensitivity & Specificity

A study by G Walch ¹ on 54 patients operated on for combined supraspinatus and infraspinatus rotator-cuff tears (Stage of fatty degeneration of infraspinatus muscle was determined by computed tomography (CT) scan), the Hornblower sign Sensitivity & Specificity were as following:

• Sensitivity: 100 %
• Specificity: 93 %

Notes

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 sign.

Hornblower test and drop arm test are used to determine the size and chronicity of rotator cuff tears. Chronic tears with fatty degeneration lead to positive findings. These tests can be helpful in determining which patients may benefit from operative intervention on their rotator cuff, since patients with fatty degeneration have a worse prognosis after tendon repair.

A suprascapular nerve palsy produces an abnormal dropping sign in the absence of an infraspinatus tear.

The vast majority of patients with tears involving the teres minor tendon had pre-existing full-thickness posterosuperior tears that propagated inferiorly as a result of acute trauma (e.g., an acute-on-chronic injury) or chronic tendon degeneration. As a result, many of these patients will have demonstrated concomitant posterosuperior cuff weakness during both the initial strength survey and subsequent provocative testing. In these cases, the hornblower’s sign is performed as described above except that the examiner must help the patient maintain an abduction angle of approximately 90° by providing support beneath the elbow. This additional support is required to optimize the strength and direction of teres minor contraction in patients who would not otherwise be capable of maintaining this level humeral abduction.

Related Anatomy

	Teres minor	Infraspinatus
Origin	Inferior scapula	Dorsal scapula
Insertion	Humerus (medial ITG)	Humerus (GT)
Action	Adducting, internally rotating, extending arm	Providing stability, externally rotating arm
Innervation	Lower subscapular nerve	Suprascapular nerve

Reference

1. 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.
2. 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.
3. Clinical Tests for the Musculoskeletal System, Third Edition book.
4. Mark Dutton, Pt . Dutton’s Orthopaedic Examination, Evaluation, And Intervention, 3rd Edition Book.
5. Millers Review of Orthopaedics, 7th Edition Book.