External rotation lag sign revisited: accuracy for diagnosis of full thickness supraspinatus tear

J Shoulder Elbow Surg. 2009 Jul-Aug;18(4):529-34. doi: 10.1016/j.jse.2008.11.007. Epub 2009 Feb 14.


Hypothesis: This study reassessed the sensitivity and the specificity of the external rotator lag sign (ERLS) for diagnosis of supraspinatus tears in a large cohort of patients.

Materials and methods: The ERLS was used to assess 401 consecutive patients with 406 painful shoulder conditions. The clinical diagnosis was controlled either arthroscopically or by open surgery.

Results: For isolated full-thickness supraspinatus tears, the ERLS had a sensitivity of 56% and a specificity of 98%. When the lesion involved the infraspinatus and the teres minor the sensitivity improved substantially. There was a strong correlation between the extension of the tear and the amount of the lag. The lag increased from 7 degrees for an isolated rupture of the supraspinatus tendon to 26 degrees in case of extension to the teres minor.

Conclusion: The ERLS is highly specific and acceptably sensitive for diagnosis of full-thickness tears, even in case of an isolated lesion of the supraspinatus tendon.

Level of evidence: Level 2; Prospective cohort treatment study.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Female
  • Humans
  • Injury Severity Score
  • Male
  • Middle Aged
  • Neurologic Examination / methods
  • Physical Examination / methods*
  • Preoperative Care / methods
  • Probability
  • Range of Motion, Articular / physiology*
  • Retrospective Studies
  • Rotator Cuff / surgery
  • Rotator Cuff Injuries*
  • Sensitivity and Specificity
  • Shoulder Injuries
  • Shoulder Joint / surgery
  • Tendon Injuries / diagnosis*
  • Tendon Injuries / surgery
  • Young Adult