Physical examination maneuver

Physical Exam

Pronator Drift

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How to Perform

Ask the patient to hold both arms outstretched in front, palms up (supinated), then close the eyes and hold the position for 20–30 seconds. A positive test is downward drift of one arm with pronation of the forearm (the palm turning inward and down).

How to Interpret

Showing 3 of 8 findings

Brain Tumor

Pronator drift positive
Rule in
Very helpfulDerived CI
Rule out
Minimally helpfulDerived CI
Evidence:Moderate

Functional Neurologic Disease

Downward drift without pronation
Rule in
Very helpfulDerived CI
Rule out
Very helpfulDerived CI
Evidence:Moderate

Upper Motor Neuron Lesion

Pronator drift positive
Rule in
HelpfulDerived CI
Rule out
Very helpfulDerived CI
Evidence:Moderate

Related Bedside Tests

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Gait Assessment
Rule in:VHStroke, HFalls, HVascular Parkinsonism +24 more
Rule out:SHDementia, SHVascular Parkinsonism, MHFalls +24 more
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Babinski Reflex
aka Plantar reflex
Rule in:VHUpper Motor Neuron Lesion, VHVascular Parkinsonism, HMultiple System Atrophy +4 more
Rule out:SHUpper Motor Neuron Lesion, MHMultiple System Atrophy, NHVascular Parkinsonism +4 more
🎬Video coming soon
Finger-to-nose
Rule in:VHMultiple System Atrophy, VHStroke, IECerebellar Disease +2 more
Rule out:MHMultiple System Atrophy, NHStroke, IECerebellar Disease +2 more
🎬Video coming soon
Heel-to-shin
aka Heel-knee-shin test
Rule in:IECerebellar Disease, IEMultiple Sclerosis, IESensory Ataxia
Rule out:IECerebellar Disease, IEMultiple Sclerosis, IESensory Ataxia
Pupillary Light ReactionMembers
Sign in
Pupillary Light Reaction
Rule in:VHSerious Eye Disease, HPoor Neurologic Outcome, HStructural Brain Lesion +11 more
Rule out:SHPoor Neurologic Outcome, SHSerious Eye Disease, SHStructural Brain Lesion +11 more
Extraocular MovementsMembers
Sign in
Extraocular Movements
Rule in:VHStroke, SHHyperthyroidism, SHMyasthenia Gravis +9 more
Rule out:HMyasthenia Gravis, SHHyperthyroidism, NHOrbital Fracture +9 more

Related Systems / Regions

NeurologicalUpper Extremities

Related Diagnoses

Brain TumorFunctional Neurologic DiseaseMultiple SclerosisParietal Lobe DiseasePosterior Column DysfunctionStrokeUnilateral Cerebellar LesionUpper Motor Neuron Lesion

Related Chief Complaints

Balance ProblemsBladder ProblemsBurning FeetClumsinessConfusionDifficulty SpeakingDifficulty WalkingDizzinessDouble VisionDrowsinessElectric Shock with Neck BendingEye Pain with MovementFacial DroopFatigueFoot NumbnessFoot PainHeadacheLoss of SensationNauseaNumbnessNumbness on One SidePersonality ChangePins and NeedlesSeizureSlurred SpeechSpasticityStiffnessSudden Vision LossTinglingVision ChangesVision Loss in One EyeVomitingWeaknessWeakness on One Side

References

  • Teitelbaum JS, Eliasziw M, Garner M. Tests of motor function in patients suspected of having mild unilateral cerebral lesions. Can J Neurol Sci. 2002 Nov;29(4):337-344. doi:10.1017/S0317167100002201. PMID 12463489.
  • Mansano JG, Silva GD. Sensitivity and Specificity of the Neurological Examination for the Diagnosis of Radiologically Confirmed Corticospinal Tract Lesions: A Systematic Review and Meta-Analysis of Diagnostic Test Accuracy Studies. SSRN preprint 4111166, posted 2022 May 16 (Preprints with The Lancet).
  • Maranhão ET, Maranhão-Filho P, Lima MA, Vincent MB. Can clinical tests detect early signs of monohemispheric brain tumors? J Neurol Phys Ther. 2010 Sep;34(3):145-149. doi:10.1097/npt.0b013e3181e5c10e. PMID 20799429. Maranhão ET. Evaluation of subtle motor deficit signs in patients with monohemispheric brain tumor. Arq Neuropsiquiatr. 2008;66(1):140-141. doi:10.1590/S0004-282X2008000100037.
  • Daum C, Aybek S. Validity of the "Drift without pronation" sign in conversion disorder. BMC Neurol. 2013;13:31. PMID: 23548051.
  • Jacobson DM. The localizing value of a quadrantanopia. Arch Neurol. 1997;54(4):401-404. PMID: 9109741.
  • McGee S. Evidence-Based Physical Diagnosis. 6th ed. Philadelphia, PA: Elsevier; 2025.

Research last updated September 10, 2026.