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External Rotation Lag Sign

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Depiction of the external rotation lag sign. A, start position; B, release[1]
External rotation lag sign[2]
Normal on the patients right (a), positive on the patients left (b)[3]
External rotation lag sign[4]
  • External Rotation Lag Sign (ERLS)
  • Lag Sign of the Shoulder
  • ERLS Test
  • Infraspinatus lag sign
  • Supraspinatus lag sign
  • External rotation lag test
  • Shoulder external rotation hold test
  • Rotator cuff lag sign
  • ER lag test
  • Infraspinatus weakness test
  • Supraspinatus weakness test
  • Dropping Sign

Purpose

Description

  • The patient is seated or standing
  • Examiner passively flexes elbow to 90°, with elbow at side
  • Examiner then brings the elbow into maximal external rotation
  • The patient is instructed to hold this position
  • Positive test
    • Patient is unable to hold this position
    • Arm begins to internally rotate

Pathology

Evidence

Full thickness Teres Minor and/or Infraspinatus

  • Castoldi et al[5]
    • Sensitivity: 100%
    • Specificity: 93%

Full thickness Supraspinatus

  • Castoldi et al[5]
    • Sensitivity: 56%
    • Specificity: 98%

Need to Clarify Muscle/Tendon groups

  • Hertel et al[6]
    • Sensitivity: 91%
    • Specificity: 100%

Rotator Cuff Disease

  • Hermans et al [7]
    • Sensitivity: 47%
    • Specificity: 94%
    • LR+: 7.2
    • LR-: 0.57

See Also

References

  1. ↑ Tennent, T. Duncan, William R. Beach, and John F. Meyers. "A review of the special tests associated with shoulder examination: part I: the Rotator Cuff tests." The American journal of sports medicine 31.1 (2003): 154-160.
  2. ↑ Phillips, Nick. "Tests for diagnosing subacromial impingement syndrome and rotator cuff disease." Shoulder & elbow 6.3 (2014): 215-221.
  3. ↑ Itoi, Eiji. "Rotator cuff tear: physical examination and conservative treatment." Journal of orthopaedic science 18.2 (2013): 197-204.
  4. ↑ Hertel, R., and F. Ballmer. "Lag signs in the diagnosis of rotator cuff rupture." Journal of Shoulder and Elbow Surgery 4 (1995): S25.
  5. ↑ 5.0 5.1 Castoldi, Filippo, Davide Blonna, and Ralph Hertel. "External rotation lag sign revisited: accuracy for diagnosis of full thickness supraspinatus tear." Journal of Shoulder and Elbow Surgery 18.4 (2009): 529-534.
  6. ↑ Hertel R, Ballmer FT, Lambert SM, Gerber C. Lag signs in the diagnosis of rotator cuff rupture. J Shoulder Elbow Surg 1996;5:307-13
  7. ↑ Hermans, Job, et al. "Does this patient with shoulder pain have rotator cuff disease?: The Rational Clinical Examination systematic review." Jama 310.8 (2013): 837-847.
Created by:
John Kiel on 17 January 2020 19:48:11
Authors:
Last edited:
24 October 2025 00:26:26
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