Hornblower Tests

What is the teres minor?

The teres minor is a small yet significant muscle located in the upper arms, specifically within the rotator cuff. Its primary function is to collaborate with the Infraspinatus muscle to enable external rotation of the shoulder. Additionally, the teres minor assists with the adduction and extension of the shoulder, playing a crucial role in various actions such as lifting, throwing, and reaching.

Damage to the teres minor can greatly impact shoulder mobility, reducing the range of motion, weakness, and pain during movement. Symptoms of a teres minor tear may include swelling, bruising, and clicking or popping sounds when the shoulder is in motion. Accidents, shoulder trauma, excessive use, or natural wear and tear over time can cause this type of injury.

What is the Hornblower Test?

The Hornblower Test is a reliable test used in orthopedic physical assessment to evaluate teres minor integrity and detect rotator cuff tears. It helps assess rotator cuff pathology by examining the patient’s ability to perform external rotation against resistance. This test is commonly performed alongside the Drop Arm Test and the External Rotation Lag Sign to provide a comprehensive evaluation of the rotator cuff.

In the traditional Hornblower Test, also known as the Patte test, the patient’s arm is passively elevated to 90 degrees in the scapular plane while they are in a standing position. The examiner then flexes the elbow to 90 degrees and instructs the patient to externally rotate the shoulder against resistance. A positive test is indicated if the patient cannot externally rotate the shoulder or shows significant weakness, suggesting teres minor tendon involvement and rotator cuff pathology. A negative test occurs when the patient is able to externally rotate without difficulty, indicating normal rotator cuff function.

A variation of this assessment, known as McCluskey’s Hornblower Test, evaluates internal rotation force by assessing the patient’s ability to bring their hands to their mouth (McCluskey, 2000).

How to use our Hornblower Test template

Carepatron has created a free Hornblower Test containing instructions on how to perform the traditional version. Follow these steps to use our free resource:

Step 1: Download the template

Click the "Use template" button to access the Hornblower Test via the Carepatron app, where you can also edit it. For a PDF version, choose "Download."

Step 2: Explain how it works

Discuss the test with your patient before proceeding. Explain that the Hornblower Test is used to assess rotator cuff injuries, particularly teres minor dysfunction. Let them know the test involves lifting their arm to a specific position while you provide resistance.

Step 3: Perform the test

Use the steps in the template to perform the test. Use the allocated "Additional notes" field to document whether the patient could perform the movement without difficulty, struggled, or experienced pain. You can also use the template to note key observations and any additional assessments required.

Step 4: Discuss next steps

Review the findings with the patient and determine if further testing, imaging, or a referral to a specialist is necessary.

What are the benefits of the Hornblower Test?

Simple, quick, and cost-effective, this test provides immediate insights into a patient’s shoulder function and helps guide further evaluation and treatment decisions. Here’s why the Hornblower Test is an essential part of shoulder assessments:

It helps in identifying functional limitations early

The Hornblower Test helps assess functional limitations in shoulder movement by detecting a potential teres minor or infraspinatus injury. Early identification allows for timely intervention, preventing further deterioration and guiding appropriate rehabilitation strategies.

It is valuable for both acute and chronic conditions

The Hornblower Test can be useful in assessing both acute injuries and chronic rotator cuff conditions. It helps identify immediate muscle dysfunction for acute cases, while in chronic conditions, it can monitor progressive weakness and guide long-term treatment plans.

It supports clinical decision-making

Since the test provides clear and observable signs of weakness or pain, it aids in clinical decision-making regarding further diagnostic tests, conservative treatment, or surgical consultation. A positive test result may prompt additional strength assessments, range of motion evaluations, or imaging for confirmation.

Reference

McCluskey, G. (2000). Classification and diagnosis of glenohumeral instability in athletes. Sports Medicine and Arthroscopy Review, 8(2), 158–169. https://journals.lww.com/sportsmedarthro/abstract/2000/08020/classification_and_diagnosis_of_glenohumeral.5.aspx