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External Rotation Lag Sign

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Other Names

External Rotation Lag Sign
Depiction of the external rotation lag sign. A, start position; B, release[1]
  • External Rotation Lag Sign (ERLS)
  • Lag Sign of the Shoulder



  • 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



Full thickness Teres Minor and/or Infraspinatus

  • Castoldi et al[2]
    • Sensitivity: 100%
    • Specificity: 93%

Full thickness Supraspinatus

  • Castoldi et al[2]
    • Sensitivity: 56%
    • Specificity: 98%

Need to Clarify Muscle/Tendon groups

  • Hertel et al[3]
    • Sensitivity: 91%
    • Specificity: 100%

See Also


  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. 2.0 2.1 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.
  3. 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
Created by:
John Kiel on 17 January 2020 19:48:11
Last edited:
18 August 2023 16:47:27