Hornblower’s Test (Patte Test)

The Hornblower’s Test is an orthopedic examination technique used to assess the integrity of the teres minor muscle and tendon. It is one of the few clinical tests that specifically targets the teres minor — an often overlooked component of the rotator cuff — and is notable for its high specificity, making a positive finding clinically significant. The test was described by Walch and colleagues in 1998, who also introduced the term signe du clairon (bugler’s sign) to describe the compensatory posture adopted by patients with a positive test.

Quick Reference

Also Called	Signe du Clairon; Bugler’s Sign
Structure Assessed	Teres minor muscle and tendon
Common Pathology	Teres minor tear; axillary nerve injury; posterior-superior rotator cuff tear
Positive Sign	Inability to externally rotate at 90° abduction; hand drops into internal rotation
Sensitivity	~69%
Specificity	~96%
Best For	Ruling in teres minor pathology; high specificity makes a positive highly meaningful

Anatomy: The Teres Minor

The teres minor is a small, cylindrical muscle that originates from the superior two-thirds of the lateral border of the scapula and inserts onto the inferior facet of the greater tubercle of the humerus. It is one of the four rotator cuff muscles — alongside the supraspinatus, infraspinatus, and subscapularis — and is innervated by the posterior branch of the axillary nerve (C5–C6).

Its primary action is external rotation of the shoulder. It works in close concert with the infraspinatus, and the two muscles share the role of posterior rotator cuff external rotators. Despite their proximity, the teres minor has a distinct nerve supply from the infraspinatus (which is innervated by the suprascapular nerve), which means isolated teres minor involvement is possible — particularly with axillary nerve injury.

Common Causes of Teres Minor Pathology

• Posterior-superior rotator cuff tears: large or massive tears involving both the infraspinatus and teres minor
• Axillary nerve injury: the posterior branch of the axillary nerve innervates the teres minor specifically; injury from shoulder dislocation, fracture, or quadrilateral space syndrome can cause isolated teres minor denervation
• Quadrilateral space syndrome: compression of the axillary nerve and posterior circumflex humeral artery in the quadrilateral space; more common in overhead athletes
• Isolated teres minor tear: uncommon in isolation; usually occurs as part of a larger posterior rotator cuff tear pattern

How to Perform the Hornblower’s Test

Patient Position

The patient sits or stands. The examiner passively elevates the patient’s arm to 90° of abduction in the scapular plane, with the elbow flexed to 90°. This starting position places the teres minor in a range where its contribution to external rotation is most easily assessed.

Test Procedure

1. With the arm abducted to 90° and the elbow flexed to 90°, passively position the forearm in maximum external rotation (forearm pointing upward).
2. Ask the patient to actively hold this externally rotated position.
3. Observe whether the patient can maintain external rotation or whether the forearm drops back toward internal rotation.
4. Alternatively, ask the patient to actively externally rotate from a neutral forearm position and observe for weakness or inability to achieve full range.

The examiner should note both the ability to hold the position and the degree of any lag — the difference between the passively achieved position and what the patient can actively maintain.

Video Demonstration

Positive Sign and Interpretation

A positive Hornblower’s Test is defined as the inability to actively externally rotate the arm at 90° abduction, or a significant lag — the forearm drops into internal rotation when the examiner releases the passively positioned arm.

The term signe du clairon (bugler’s sign) describes the compensatory posture that patients with a positive test adopt in daily life. Unable to externally rotate the elevated arm, they bring the hand to the mouth or face by internally rotating the shoulder and using the opposite side for compensation — a posture resembling someone raising a bugle or horn to their lips from below.

Grading the Positive

• Complete inability to externally rotate: consistent with a complete teres minor tear or significant axillary nerve injury
• External rotation lag: the patient achieves external rotation passively but cannot hold it actively — suggests significant teres minor insufficiency
• Weakness with maintained range: partial tear or incomplete nerve injury; compare carefully to the contralateral side

Sensitivity and Specificity

The Hornblower’s Test has been evaluated primarily in the context of posterior-superior rotator cuff pathology. Its most consistent and clinically useful characteristic is its high specificity — a positive test is rarely seen in the absence of teres minor pathology.

Pathology	Sensitivity	Specificity	LR+	LR−
Teres minor tear / posterior cuff pathology	~69%	~96%	~17	~0.32

The positive likelihood ratio of ~17 is among the highest of any rotator cuff test — a positive result substantially increases the probability of teres minor pathology. However, sensitivity of ~69% means that a meaningful proportion of teres minor tears will produce a negative test. A negative Hornblower’s Test does not rule out teres minor involvement, particularly in partial tears or early nerve injury where some external rotation capacity is preserved.

Clinical Considerations

• Distinguish teres minor from infraspinatus involvement. Both muscles produce external rotation, and isolated testing can be difficult. The Hornblower’s Test at 90° abduction biases toward teres minor; external rotation lag testing at 0° abduction biases more toward the infraspinatus. A patient with weakness at 90° but relatively preserved strength at 0° suggests teres minor predominance.
• Consider axillary nerve injury. A positive Hornblower’s Test in a patient with a history of shoulder dislocation, fracture, or trauma may reflect axillary nerve injury rather than a structural tendon tear. Electrodiagnostic testing (EMG/NCS) is useful when nerve involvement is suspected. Teres minor denervation on MRI (fatty infiltration or edema without a visible tear) is a key imaging finding in this scenario.
• Massive rotator cuff tears. The Hornblower’s Test is particularly useful in the workup of massive posterior-superior cuff tears. Teres minor involvement in a massive tear has prognostic implications — fatty infiltration of the teres minor on MRI is associated with worse outcomes following rotator cuff repair and may influence surgical planning.
• Combine with the Dropping Sign. The Dropping Sign (inability to hold the arm in external rotation at 0° abduction when released) assesses infraspinatus integrity. Using both tests together gives a more complete picture of posterior rotator cuff function.
• Quadrilateral space syndrome in athletes. Young overhead athletes with a positive Hornblower’s Test and no visible cuff tear on MRI should be evaluated for quadrilateral space syndrome. MRI may show teres minor denervation changes; MR arthrography or dynamic ultrasound may be needed to assess the space.

Related Tests

• Dropping Sign — tests infraspinatus integrity; the arm is passively externally rotated at 0° abduction and released; a drop back toward internal rotation is positive
• External Rotation Lag Sign — similar to the Hornblower’s position but specifically measures the lag between passive and active external rotation; highly specific for posterior cuff tears
• Gerber’s Lift-Off Test — tests subscapularis integrity; completes the rotator cuff assessment by evaluating the anterior cuff
• Empty Can Test / Full Can Test — assesses supraspinatus integrity; useful alongside posterior cuff tests for comprehensive evaluation

Frequently Asked Questions

What does a positive Hornblower’s Test mean?

It means the patient cannot actively externally rotate the arm at 90° abduction, or has a significant lag when the position is passively held and released. Given the test’s high specificity (~96%), a positive result is a strong indicator of teres minor pathology — either a structural tear or axillary nerve injury causing denervation. Imaging is the appropriate next step.

Why is it called the Hornblower’s Test?

The name comes from the compensatory posture patients adopt in daily life when teres minor function is lost. Unable to externally rotate the elevated arm, they bring the hand toward the face from below by internally rotating at the shoulder — a motion resembling someone raising a bugle or horn to their lips. In French, the test is called signe du clairon, meaning “bugler’s sign.”

How is the Hornblower’s Test different from the Dropping Sign?

Both test the posterior rotator cuff, but they assess different muscles. The Dropping Sign is performed at 0° abduction and primarily reflects infraspinatus function. The Hornblower’s Test is performed at 90° abduction and targets the teres minor more specifically. Using both together gives a more complete assessment of the posterior rotator cuff.

Can the Hornblower’s Test be positive without a rotator cuff tear?

Yes. Axillary nerve injury — from shoulder dislocation, fracture, or quadrilateral space syndrome — can produce a positive test without any structural tendon tear. The teres minor is innervated by the posterior branch of the axillary nerve specifically, making it vulnerable to isolated denervation. If the history involves trauma or the patient is a young overhead athlete, nerve injury should be considered alongside structural cuff pathology.

Does teres minor involvement affect surgical outcomes?

Yes. Fatty infiltration of the teres minor muscle belly — a sign of chronic denervation or longstanding tear — is associated with worse functional outcomes following rotator cuff repair. MRI assessment of teres minor muscle quality is therefore part of surgical planning for massive posterior-superior cuff tears.

Is a negative Hornblower’s Test enough to rule out teres minor pathology?

Not definitively. Sensitivity of ~69% means roughly 3 in 10 teres minor tears may produce a negative test — particularly partial tears or early nerve injury where some external rotation capacity is preserved. If clinical suspicion remains, MRI with attention to teres minor morphology and signal intensity is the appropriate next step.

References

1. Walch G, Boulahia A, Calderone S, Robinson AH. The ‘dropping’ and ‘hornblower’s’ signs in evaluation of rotator-cuff tears. J Bone Joint Surg Br. 1998;80(4):624–628.
2. Hegedus EJ, Goode AP, Cook CE, et al. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med. 2012;46(14):964–978.
3. Collin P, Treseder T, Lädermann A, et al. Neuropathy of the suprascapular nerve and the anatomy of the suprascapular notch: a review. Surg Radiol Anat. 2014;36(5):409–415.
4. Castagna A, Garofalo R, Cesari E, Markopoulos N, Borroni M, Conti M. Posterior superior rotator cuff tears: classification and surgical repair. Orthopedics. 2009;32(7):519.

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