Drop Arm Test
- Fysiobasen
- Oct 4
- 2 min read
The Drop Arm Test is a widely used orthopedic clinical examination designed to assess full-thickness rotator cuff tears, particularly involving the supraspinatus tendon¹. It is also relevant in the diagnostic process for subacromial impingement syndrome and helps differentiate between general shoulder pathology and rotator cuff disorders.
Since no single test provides perfect diagnostic accuracy, the Drop Arm Test is most effective when combined with other rotator cuff tests, including:
Empty Can / Full Can Test
External Rotation Lag Sign
Internal Rotation Lag Sign
Hornblower’s Sign
A cluster of tests increases diagnostic precision and clinical decision-making reliability¹.
Test Procedure
Patient Position
Patient sits upright while the examiner stands behind.
Execution
The examiner passively abducts the patient’s arm to 90° abduction with full external rotation, supporting at the elbow.
The patient is then instructed to slowly and smoothly lower the arm back to the side.
Positive Test
The arm drops suddenly and uncontrollably.
The patient cannot maintain a smooth eccentric lowering.
Pain may also occur, strongly suggesting a full-thickness supraspinatus tear⁴.
Negative Test
Patient lowers the arm in a controlled and pain-free manner.
Interpretation and Diagnostic Accuracy
Sensitivity: 73% (moderate ability to detect tears)⁵
Specificity: 77% (moderate ability to exclude tears)⁵
Likelihood Ratio (LR+): 6.45 (95% CI = 2.25–18.47)⁶ → A positive result strongly indicates rotator cuff rupture.
Clinical Evidence
Uncertainty remains whether a full-thickness rotator cuff tear can be diagnosed with Drop Arm Test alone⁵.
Clinical shoulder tests in general have high specificity but low sensitivity⁶.
Combining the Drop Arm Test with other rotator cuff integrity tests improves diagnostic accuracy and may reduce reliance on imaging such as MRI or ultrasound, cutting waiting time and healthcare costs⁷.
Summary
The Drop Arm Test is a clinically valuable tool for detecting rotator cuff pathology, especially supraspinatus tears. While moderately sensitive and specific, it is most reliable when used in conjunction with other special tests. A positive result, particularly in combination with corroborating tests, significantly increases the likelihood of a full-thickness rotator cuff rupture.
References
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
Clinical Physio. Shoulder Drop Arm Test for Rotator Cuff Tear | Clinical Physio. Available from: https://www.youtube.com/watch?v=Dk9KTNbcaZ8&ab_channel=ClinicalPhysio (accessed 15/05/2024).
Jain NB, Wilcox III RB, Katz JN, Higgins LD. Clinical examination of the rotator cuff. PM&R. 2013 Jan 1;5(1):45-56.
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.
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.
