Prospective study of 100 operative shoulders evaluating three new physical exam tests against the Jobe and lift-off signs. All clinical findings were correlated with intraoperative diagnosis. The paper establishes ERLS lag magnitude as a bedside predictor of tear extent and the IRLS as a superior test for subscapularis pathology.
The Jobe sign was the dominant test for posterosuperior cuff tears before this paper, but its sensitivity to pain meant a positive result in an aching shoulder told you little — reflex inhibition mimics true weakness.
When you need to confirm a cuff tear in clinic, use the ERLS: a positive result means a tear is present, full stop (100% PPV). Then read the lag: 5°–10° points to isolated supraspinatus, 10°–15° implicates infraspinatus as well. This is bedside staging without imaging.
For subscapularis assessment, the IRLS should replace the lift-off sign as your primary test. Its 96% NPV means a negative result is genuinely reassuring. The lift-off sign has only 69% NPV and will miss every partial subscapularis tear.
One critical pitfall: assess passive range of motion before any lag test. Capsular contracture masks lags (false negative); suprascapular nerve palsy mimics massive tears (false positive on both ERLS and drop sign).
Prospective study of 100 operative shoulders evaluating three new physical exam tests against the Jobe and lift-off signs. All clinical findings were correlated with intraoperative diagnosis. The paper establishes ERLS lag magnitude as a bedside predictor of tear extent and the IRLS as a superior test for subscapularis pathology.
The Jobe sign was the dominant test for posterosuperior cuff tears before this paper, but its sensitivity to pain meant a positive result in an aching shoulder told you little — reflex inhibition mimics true weakness.
When you need to confirm a cuff tear in clinic, use the ERLS: a positive result means a tear is present, full stop (100% PPV). Then read the lag: 5°–10° points to isolated supraspinatus, 10°–15° implicates infraspinatus as well. This is bedside staging without imaging.
For subscapularis assessment, the IRLS should replace the lift-off sign as your primary test. Its 96% NPV means a negative result is genuinely reassuring. The lift-off sign has only 69% NPV and will miss every partial subscapularis tear.
One critical pitfall: assess passive range of motion before any lag test. Capsular contracture masks lags (false negative); suprascapular nerve palsy mimics massive tears (false positive on both ERLS and drop sign).