This retrospective study of 54 patients correlated two external-rotation exam signs with CT-graded fatty degeneration of the posterior cuff. It asks whether the dropping and hornblower's signs can predict irreparable infraspinatus and teres minor degeneration before surgery.
When you see a patient with a chronic posterosuperior cuff tear, these two signs let you predict reparability at the bedside, before the CT or MRI. A positive dropping sign means the infraspinatus is gone (Goutallier stage 3-4) and a repair will likely re-rupture. A positive hornblower's sign adds irreparable teres minor loss.
This is why these signs belong in your massive-cuff-tear workup: they screen for the same fatty degeneration that drives a 50% re-rupture rate and that now defines candidacy for tendon transfer or superior capsule reconstruction rather than primary repair.
A practical pearl: an intact or hypertrophied teres minor (negative hornblower's, positive dropping only) preserves external rotation for eating and drinking, so do not assume a massive tear means a poorly functioning shoulder. The study is retrospective and small, and intraoperative muscle status was not recorded, so treat the perfect specificity as a strong signal rather than absolute certainty.
This retrospective study of 54 patients correlated two external-rotation exam signs with CT-graded fatty degeneration of the posterior cuff. It asks whether the dropping and hornblower's signs can predict irreparable infraspinatus and teres minor degeneration before surgery.
When you see a patient with a chronic posterosuperior cuff tear, these two signs let you predict reparability at the bedside, before the CT or MRI. A positive dropping sign means the infraspinatus is gone (Goutallier stage 3-4) and a repair will likely re-rupture. A positive hornblower's sign adds irreparable teres minor loss.
This is why these signs belong in your massive-cuff-tear workup: they screen for the same fatty degeneration that drives a 50% re-rupture rate and that now defines candidacy for tendon transfer or superior capsule reconstruction rather than primary repair.
A practical pearl: an intact or hypertrophied teres minor (negative hornblower's, positive dropping only) preserves external rotation for eating and drinking, so do not assume a massive tear means a poorly functioning shoulder. The study is retrospective and small, and intraoperative muscle status was not recorded, so treat the perfect specificity as a strong signal rather than absolute certainty.