Shoulder Orthopaedic Test: Hornblower's Sign

Hornblower's sign is a clinical test used to assess for a teres minor muscle tear or pathology. 

Here's how the test is performed:

1. The patient is positioned in a prone position (lying face down) with the arm in 90 degrees of abduction and the elbow flexed to 90 degrees.
2. The examiner stabilizes the scapula with one hand and then passively externally rotates the patient's arm against resistance with the other hand.
3. The examiner then asks the patient to hold the arm in external rotation while they release the resistance.
4. The patient is then asked to relax the arm.
5. The examiner then passively internally rotates the patient's arm against resistance with the other hand.
6. The examiner then asks the patient to hold the arm in internal rotation while they release the resistance.
7. The patient is then asked to relax the arm.
8. If the patient is unable to maintain external rotation of the arm or has weakness during external rotation but is able to maintain internal rotation of the arm without weakness, this is indicative of a positive Hornblower's sign and suggests teres minor pathology.

References:

1. Kim, S. H., Park, J. S., Jeong, W. K., Shin, S. K., & Rhee, Y. G. (2007). Hornblower's sign: a new clinical test for detecting a tear of the teres minor tendon in massive rotator cuff tears. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 23(10), 1091-1095.
2. Park, J. Y., Chung, S. W., Jeong, W. K., & Kim, J. Y. (2018). Hornblower's sign revisited: A more sensitive and specific predictor of teres minor tendon injury in massive rotator cuff tears. Journal of Shoulder and Elbow Surgery, 27(10), 1787-1793.
3. Constant, C. R. (2007). Evaluation of the shoulder. Churchill Livingstone.