Understanding the Internal Rotation Lag Sign Assessment
To detect a **full-thickness tear of the subscapularis tendon**.
Watch How It's Done
How do I start?
Patient is sitting or standing. The affected arm is behind the back, with the hand actively placed away from the back (Lift-Off position is achieved).
What happens?
Patient is seated with examiner standing behind the patient. The affected arm is brought into maximal internal rotation behind the back (dorsum of patients hand against the lumbar region). Examiner controls patient's arm at the elbow and wrist/hand which is passively brought into 20 degrees of extension, taking the forearm and hand away from the back. The patient is instructed to actively maintain this position, as the examiner releases the wrist but maintains support at the elbow.
In Plain English
What Does a Positive Result Mean?
The patient is **unable to hold the position** and the hand 'lags' or drops back toward the back/spine (loss of internal rotation), indicating subscapularis tear.
Helpful Tip:
A very specific test for subscapularis tear, especially a large or complete tear.
Safety First
This guide is to help you understand what happens in a clinic. Do not try to diagnose yourself. If you have severe pain, swelling, or cannot put weight on your leg, please visit an urgent care center or your doctor immediately.
Other shoulder Tests
Adson's Test
To assess for Thoracic Outlet Syndrome (TOS) due to compression of the neurovascular bundle by the anterior and middle scalene muscles.
Anterior Drawer Test Of The Shoulder
To assess for anterior glenohumeral joint laxity and instability and the integrity of the anterior capsular structures.
Arm Squeeze Test
This is a new clinical test that may be useful to distinguish between Cervical radiculopathy from other shoulders related pathology. The anatomic reasoning behind this test is that because the musculocutaneous nerve (cervical root from C5 to C7), the radial nerve (from C5 to T1), the ulnar nerve (from C7 to T1), and the median nerve (from C5 to T1) are relatively superficial in the middle third of the arm and easy to elicit a painful provocation response by squeezing the arm. A moderate compression of skin, subcutis, and muscle by squeezing the middle third of the upper arm (brachial biceps and triceps area) on the side with shoulder pain elicits an intense reaction of local pain only in patients with cervical nerve root compression from C5 to T1, not when the pain arises from the shoulder.
Bear Hug Test
To assess for a tear or significant weakness in the **subscapularis tendon** (subscapularis strength).