Physical Exam

Shoulder Strength

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Video coming September 2026

How to Perform

Test the major shoulder movements against resistance, comparing sides: resisted abduction, forward flexion, and internal and external rotation, with elbow flexion and extension as appropriate. Stabilize as needed and apply steady resistance through the range or at a set position, grading the strength and noting any pain or give-way weakness.

How to Interpret

Infraspinatus Tear

A positive external rotation lag sign — with the elbow flexed and the shoulder held in near-maximal external rotation, the patient cannot maintain the position when released and the arm springs back (a measurable lag)

Rule in

Helpful

Rule out

—

Evidence:Limited

References

Zhao Q, Palani P, Kassab NS, Terzic M, Olejnik M, Wang S, Tomassini-Lopez Y, Dean C, Shellenberger RA. Evidence-based approach to the shoulder examination for subacromial bursitis and rotator cuff tears: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2024 Dec 19;25(1):1028. doi:10.1186/s12891-024-08144-z. PMID 39702033.
Hermans J, Luime JJ, Meuffels DE, Reijman M, Simel DL, Bierma-Zeinstra SMA. Does this patient with shoulder pain have rotator cuff disease? The Rational Clinical Examination systematic review. JAMA. 2013;310(8):837-47. PMID: 23982370.
Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.