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Comparative Study
. 2008 Nov;466(11):2813-9.
doi: 10.1007/s11999-008-0331-3. Epub 2008 Jun 10.

Clinical evaluation of the shoulder shrug sign

Xiaofeng Jia  1 , Jong-Hun Ji, Steve A Petersen, Jennifer Keefer, Edward G McFarland
Affiliations
Comparative Study

Clinical evaluation of the shoulder shrug sign

Xiaofeng Jia et al. Clin Orthop Relat Res. 2008 Nov.

Abstract

The "shrug sign" (inability to lift the arm to 90 degrees abduction without elevating the whole scapula or shoulder girdle) has been associated with a diagnosis of rotator cuff disease. Based on our clinical experience, we hypothesized the shrug sign is not a specific diagnostic sign for this condition, but rather is associated with various shoulder conditions and shoulder weakness and loss of range of motion. We retrospectively reviewed 982 consecutive patients who had been examined preoperatively for the shrug sign. A positive shrug sign was present in 51.3% of the patients, and the average distance lost from the horizontal was 20.5 degrees +/- 2.2 degrees (standard error of mean). Increasing age was associated with the presence of a shrug sign. The highest incidence was in patients with adhesive capsulitis (94.7%). The shrug sign was not sensitive for tendinosis, partial rotator cuff tears, or full-thickness or massive rotator cuff tears. The shrug sign was associated with weakness in abduction, night pain, and loss of range of motion, especially passive abduction. Although the shrug sign is useful as a general sign of shoulder abnormality, particularly when associated with stiffness, it was not specific or sensitive for rotator cuff problems.

Level of evidence: Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Figures

Fig. 1
Fig. 1
A shrug sign was considered positive if the patient had to elevate the shoulder girdle for the arm to reach 90° abduction. The right shoulder shows a shrug sign; the left shoulder is normal.
Fig. 2
Fig. 2
The degree of shrug sign was measured with a handheld goniometer. The patient was asked to elevate the arm until the shrug sign began, and then the angle between the horizontal and the arm was measured as shown.
See this image and copyright information in PMC

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