Patte's test (Hornblower’s sign)
- Fysiobasen
- Oct 3
- 2 min read
Patte’s Test, also known as the Hornblower’s Sign, is used to assess the strength of the teres minor muscle. Weakness or pain during this test may indicate a tear of the teres minor or a larger posterior rotator cuff tear¹. In severe cases, the Hornblower’s Sign is considered a marker of massive and often irreparable rotator cuff injury.
Test execution
Patient position
The patient stands upright¹.
Passive positioning
The examiner abducts the patient’s arm to 90° in the scapular plane.
The elbow is flexed to 90°.
Active movement
The patient is instructed to actively externally rotate the shoulder against resistance from the examiner.
Alternative method (McClusky’s variant)²
The patient stands with arms at the side.
They are asked to bring both hands to the mouth.
In cases of large posterior rotator cuff tears, the patient cannot perform this movement without first abducting the arms.
This compensatory abduction movement is referred to as the Hornblower’s Sign
Interpretation
Positive test
Inability to externally rotate the shoulder against resistance or pain during the maneuver suggests:
Teres minor rupture
Large posterior rotator cuff tear¹
Presence of the Hornblower’s Sign often indicates a massive, irreparable rotator cuff tear.
Diagnostic validity
Sensitivity: 100%
Specificity: 93%
Positive likelihood ratio (LR+): 14.29
Negative likelihood ratio (LR–): 0.0¹⁴⁵
These values demonstrate very high diagnostic accuracy. Patte’s Test is therefore a reliable tool for assessing posterior rotator cuff integrity and is often performed in conjunction with other rotator cuff tests for comprehensive evaluation¹.
Clinical relevance
A highly specific and sensitive test for diagnosing posterior rotator cuff tears, particularly involving the teres minor.
A positive Hornblower’s Sign strongly indicates a massive rotator cuff tear, often associated with poor reparability.
Should always be interpreted alongside other clinical tests, imaging (ultrasound, MRI), and patient history for accurate diagnosis.
Conclusion
Patte’s Test, or the Hornblower’s Sign, is a simple and highly accurate clinical test for evaluating teres minor strength and detecting posterior rotator cuff tears. With a sensitivity of 100% and specificity of 93%, it provides strong diagnostic value, especially when combined with additional rotator cuff tests. The presence of the Hornblower’s Sign often indicates massive and potentially irreparable rotator cuff injury, making this test clinically significant in surgical and rehabilitation decision-making.
References
Magee D. J. Shoulder. Orthopedic Physical Assessment. 7th Edition. Philadelphia. Elsevier. 2022.
McClusky CM. Classification and diagnosis of glenohumeral instability in athletes. Sports Medicine and Arthroscopy Review. 2000:8:158–169.
Clinically Relevant Technologies, http://www.youtube.com/watch?v=KcNBtbVaatY; Accessed May 2011
Walch G, Boulahia A, Calderone S, Robinson AHN. The 'dropping' and 'hornblower's' signs in evaluation of rotator cuff tears. 1998; 80: 624-28.
Cleland J, 2005, Orthopedic Clinical Examination: An Evidence-Based Approach for Physical Therapists, 1st edition, New Jersey: Icon Learning Systems LLC.
