Drop Arm Test: Difference between revisions
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'''Original Editor '''- [[User: | '''Original Editor '''- [[User:Beth Reuschel|Beth Reuschel]] | ||
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== Purpose | == Purpose == | ||
The drop arm test is used to assess for [[Rotator Cuff Tears|rotator cuff tears]], particularly of the [[Supraspinatus | The drop arm test is used to assess for full thickness [[Rotator Cuff Tears|rotator cuff tears]], particularly of the [[Supraspinatus Tear|supraspinatus]]<ref name=":0">Sgroi M, Loitsch T, Reichel H, Kappe T. [https://www.sciencedirect.com/science/article/abs/pii/S0749806318302755 Diagnostic value of clinical tests for supraspinatus tendon tears.] Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2018 Aug 1;34(8):2326-33.</ref>. This can be useful when diagnosing sub-acromial pain syndrome ([[Impingement / Instability Differentiation|shoulder impingment]]) or to differentiate between shoulder and [[Rotator Cuff Tendinopathy|rotator cuff pathologies]]. | ||
< | The drop arm test may be more accurate when used in a battery of tests such as: | ||
* [[Empty Can Test|empty/full can test]], | |||
* [https://physio-pedia.com/External_Rotation_Lag_Sign_(ERLS)_Test external rotation lag sign] | |||
* [https://physio-pedia.com/Internal_Rotation_Lag_Sign?utm_source=physiopedia&utm_medium=related_articles&utm_campaign=ongoing_internal internal rotation lag sign] | |||
* [[Hornblower's Sign|Hornblower's sign]] | |||
Performing a battery of tests will help to differentiate between rotator cuff muscles and give more accurate diagnosis<ref name=":0" />. | |||
== Technique< | == Technique == | ||
# Stand behind the seated patient and passively abduct the patient's arm to 90<sup>0</sup> and full external rotation, while supporting the arm at the elbow | |||
# Release the elbow support and ask patient to slowly lower the arm back to neutral.<ref name="buckup">Klaus Buckup. Clinical Tests for the Musculoskeletal System: Examinations - Signs - Phenomena. 2nd ed. Germany: Thieme, 2008</ref> | |||
== Instructional video == | |||
{{#ev:youtube|v=JXgRBeqToik}}<ref>Physiotutors. Drop Arm Test/sign | Supraspinatus Tear. Available from: https://www.youtube.com/watch?v=JXgRBeqToik [last accessed 3/7/17]</ref> | |||
== Interpretation == | |||
The test is <u>negative</u> if the patient is able to control the lowering of the arm slowly and without their symptoms occurring. | |||
It is a <u>positive</u> test if there is a sudden dropping of the arm or weakness in maintaining arm position during the eccentric part of abduction, there may also be pain present while lowering the arm, suggesting a full thickness tear to the supraspinatus<ref>Jain NB, Wilcox III RB, Katz JN, Higgins LD. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3826176/ Clinical examination of the rotator cuff.] PM&R. 2013 Jan 1;5(1):45-56.</ref>.<br> | |||
< | == Sensitivity / Specificity == | ||
<u>Sensitivity</u> of detecting a full thickness supraspinatus tear: 73%<ref name=":1">Miller CA, Forrester GA, Lewis JS. [https://pubmed.ncbi.nlm.nih.gov/18503815/ The validity of the lag signs in diagnosing full-thickness tears of the rotator cuff: a preliminary investigation]. Archives of physical medicine and rehabilitation. 2008 Jun 1;89(6):1162-8.</ref> and a <u>Specificity</u> of: 77%<ref name=":1" /> | |||
Likelihood Ratio: 6.45 (95% CI=2.25–18.47)<ref name=":2" /><br> | |||
== Evidence == | == Evidence == | ||
It was found it is unclear if a full thickness rotator cuff tear can be diagnosed by using any of the cluster of lag signs, let alone solely the drop arm sign<ref name=":1" />. | |||
< | All lag sign tests for rotator cuff integrity have been shown to have high specificity but low sensitivity<ref name=":2">Jain NB, Luz J, Higgins LD, Dong Y, Warner JJ, Matzkin E, Katz JN. [https://pubmed.ncbi.nlm.nih.gov/27386812/ The diagnostic accuracy of special tests for rotator cuff tear: the ROW cohort study.] American journal of physical medicine & rehabilitation. 2017 Mar;96(3):176.</ref>. | ||
It is recommended to use a cluster of tests in order to assess the full capacity of the rotator cuff which will lessen waiting times and costs for radiographic imaging such as US or MRI.<ref>Lädermann A, Meynard T, Denard PJ, Ibrahim M, Saffarini M, Collin P. [https://pubmed.ncbi.nlm.nih.gov/32725446/ Reliable diagnosis of posterosuperior rotator cuff tears requires a combination of clinical tests.] Knee Surgery, Sports Traumatology, Arthroscopy. 2020 Jul 28:1-6.</ref> | |||
== References == | == References == | ||
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<references /> | <references /> | ||
[[Category:Shoulder]] [[Category:Musculoskeletal/Orthopaedics|Orthopaedics]] [[Category:Assessment]] | [[Category:Shoulder]] | ||
[[Category:Musculoskeletal/Orthopaedics|Orthopaedics]] | |||
[[Category:Assessment]] | |||
[[Category:Primary Contact]] | |||
[[Category:Sports Medicine]] | |||
[[Category:Athlete Assessment]] | |||
[[Category:Special Tests]] | |||
[[Category:Shoulder - Special Tests]] | |||
Revision as of 20:09, 22 February 2021
Original Editor - Beth Reuschel
Top Contributors - Admin, Abbey Wright, Venus Pagare, Kim Jackson, WikiSysop, Kai A. Sigel, Claire Knott, Wanda van Niekerk, Jennifer Chew, Kapil Narale, 127.0.0.1, Tony Lowe, Beth Reuschel, Laura Ritchie and Oyemi Sillo
Purpose[edit | edit source]
The drop arm test is used to assess for full thickness rotator cuff tears, particularly of the supraspinatus[1]. This can be useful when diagnosing sub-acromial pain syndrome (shoulder impingment) or to differentiate between shoulder and rotator cuff pathologies.
The drop arm test may be more accurate when used in a battery of tests such as:
Performing a battery of tests will help to differentiate between rotator cuff muscles and give more accurate diagnosis[1].
Technique[edit | edit source]
- Stand behind the seated patient and passively abduct the patient's arm to 900 and full external rotation, while supporting the arm at the elbow
- Release the elbow support and ask patient to slowly lower the arm back to neutral.[2]
Instructional video[edit | edit source]
Interpretation[edit | edit source]
The test is negative if the patient is able to control the lowering of the arm slowly and without their symptoms occurring.
It is a positive test if there is a sudden dropping of the arm or weakness in maintaining arm position during the eccentric part of abduction, there may also be pain present while lowering the arm, suggesting a full thickness tear to the supraspinatus[4].
Sensitivity / Specificity[edit | edit source]
Sensitivity of detecting a full thickness supraspinatus tear: 73%[5] and a Specificity of: 77%[5]
Likelihood Ratio: 6.45 (95% CI=2.25–18.47)[6]
Evidence[edit | edit source]
It was found it is unclear if a full thickness rotator cuff tear can be diagnosed by using any of the cluster of lag signs, let alone solely the drop arm sign[5].
All lag sign tests for rotator cuff integrity have been shown to have high specificity but low sensitivity[6].
It is recommended to use a cluster of tests in order to assess the full capacity of the rotator cuff which will lessen waiting times and costs for radiographic imaging such as US or MRI.[7]
References[edit | edit source]
- ↑ 1.0 1.1 Sgroi M, Loitsch T, Reichel H, Kappe T. Diagnostic value of clinical tests for supraspinatus tendon tears. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2018 Aug 1;34(8):2326-33.
- ↑ Klaus Buckup. Clinical Tests for the Musculoskeletal System: Examinations - Signs - Phenomena. 2nd ed. Germany: Thieme, 2008
- ↑ Physiotutors. Drop Arm Test/sign | Supraspinatus Tear. Available from: https://www.youtube.com/watch?v=JXgRBeqToik [last accessed 3/7/17]
- ↑ Jain NB, Wilcox III RB, Katz JN, Higgins LD. Clinical examination of the rotator cuff. PM&R. 2013 Jan 1;5(1):45-56.
- ↑ 5.0 5.1 5.2 Miller CA, Forrester GA, Lewis JS. The validity of the lag signs in diagnosing full-thickness tears of the rotator cuff: a preliminary investigation. Archives of physical medicine and rehabilitation. 2008 Jun 1;89(6):1162-8.
- ↑ 6.0 6.1 Jain NB, Luz J, Higgins LD, Dong Y, Warner JJ, Matzkin E, Katz JN. The diagnostic accuracy of special tests for rotator cuff tear: the ROW cohort study. American journal of physical medicine & rehabilitation. 2017 Mar;96(3):176.
- ↑ Lädermann A, Meynard T, Denard PJ, Ibrahim M, Saffarini M, Collin P. Reliable diagnosis of posterosuperior rotator cuff tears requires a combination of clinical tests. Knee Surgery, Sports Traumatology, Arthroscopy. 2020 Jul 28:1-6.
