Physical examination maneuver

Physical Exam

Pronator Drift

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Video coming September 2026

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 4 of 8 findings

Brain Tumor

Pronator drift positive
Rule in
Very helpfulNo CI
Rule out
Minimally helpfulNo CI
Evidence:LimitedResearch in progress

Functional Neurologic Disease

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

Stroke

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

Upper Motor Neuron Lesion

Pronator drift positive
Rule in
Not helpfulDerived CI
Rule out
Not helpfulDerived CI
Evidence:Limited

References

Research in progress on one or more findings above; ratings may change.

  • 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.
  • Anderson NE, Mason DF, Fink JN, Bergin PS, Charleston AJ, Gamble GD. Detection of focal cerebral hemisphere lesions using the neurological examination. J Neurol Neurosurg Psychiatry. 2005 Apr;76(4):545-549. doi:10.1136/jnnp.2004.043679. PMID 15774443. PMC1739581.
  • 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, Maranhão-Filho P, Lima MA, Vincent MB. 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.

Related Systems / Regions

NeurologicalUpper Extremities

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