Walch and colleagues tested whether the dropping and hornblower's signs of weak external rotation identify Goutallier stage 3 or 4 fatty degeneration in infraspinatus and teres minor in patients with combined supraspinatus and infraspinatus tears.
Retrospective review of 54 of 161 patients with combined supraspinatus and infraspinatus tears treated surgically by one surgeon in Lyon, 1988 to 1995.
Methods
Design
Retrospective diagnostic correlation
Single senior surgeon, 1988 to 1995
Patients
54 patients
Surgically treated for tears involving both supraspinatus and infraspinatus
Tear more than 1 year old, full passive motion, intact subscapularis
33 men and 21 women, mean age 66
Index test
Dropping sign
Hornblower's sign
Reference standard
Goutallier stage 3 or 4 fatty degeneration of infraspinatus on preoperative CT arthrogram
Goutallier stage 3 or 4 fatty degeneration, or absence, of teres minor
Outcomes
Sensitivity
Specificity
Teres minor hypertrophy
Key Findings
The dropping sign was 100% sensitive and 100% specific for irreparable (stage 3 or 4) fatty degeneration of infraspinatus.
The hornblower's sign was 100% sensitive and 93% specific for stage 3 or 4 fatty degeneration or complete absence of teres minor.
None of the 29 patients without either sign had infraspinatus degeneration beyond stage 2 or teres minor degeneration beyond stage 1.
Teres minor was hypertrophied in 7 of the 12 patients with a dropping sign but no hornblower's sign.
For teres minor degeneration, the dropping sign was 100% sensitive but only 66% specific.
The authors concluded that teres minor contributes to external rotation at 90° of abduction in the scapular plane but not at 0°, so its function shows in hornblower's sign.
Board pearl
A positive dropping sign indicates stage 3 or 4 fatty degeneration of infraspinatus, and a positive hornblower's sign indicates stage 3 or 4 degeneration or absence of teres minor.
Authors' conclusion
In seven patients, teres minor showed hypertrophy. This muscle can give useful function for the activities of daily living in patients with rotator-cuff tears in whom it is intact.
Walch and colleagues tested whether the dropping and hornblower's signs of weak external rotation identify Goutallier stage 3 or 4 fatty degeneration in infraspinatus and teres minor in patients with combined supraspinatus and infraspinatus tears.
Retrospective review of 54 of 161 patients with combined supraspinatus and infraspinatus tears treated surgically by one surgeon in Lyon, 1988 to 1995.
Methods
Design
Retrospective diagnostic correlation
Single senior surgeon, 1988 to 1995
Patients
54 patients
Surgically treated for tears involving both supraspinatus and infraspinatus
Tear more than 1 year old, full passive motion, intact subscapularis
33 men and 21 women, mean age 66
Index test
Dropping sign
Hornblower's sign
Reference standard
Goutallier stage 3 or 4 fatty degeneration of infraspinatus on preoperative CT arthrogram
Goutallier stage 3 or 4 fatty degeneration, or absence, of teres minor
Outcomes
Sensitivity
Specificity
Teres minor hypertrophy
Key Findings
The dropping sign was 100% sensitive and 100% specific for irreparable (stage 3 or 4) fatty degeneration of infraspinatus.
The hornblower's sign was 100% sensitive and 93% specific for stage 3 or 4 fatty degeneration or complete absence of teres minor.
None of the 29 patients without either sign had infraspinatus degeneration beyond stage 2 or teres minor degeneration beyond stage 1.
Teres minor was hypertrophied in 7 of the 12 patients with a dropping sign but no hornblower's sign.
For teres minor degeneration, the dropping sign was 100% sensitive but only 66% specific.
The authors concluded that teres minor contributes to external rotation at 90° of abduction in the scapular plane but not at 0°, so its function shows in hornblower's sign.
Board pearl
A positive dropping sign indicates stage 3 or 4 fatty degeneration of infraspinatus, and a positive hornblower's sign indicates stage 3 or 4 degeneration or absence of teres minor.
Authors' conclusion
In seven patients, teres minor showed hypertrophy. This muscle can give useful function for the activities of daily living in patients with rotator-cuff tears in whom it is intact.