You’re evaluating a patient with shoulder pain after a fall. As you passively elevate their arm overhead, it’s smooth, but the moment you ask them to lower it slowly, their arm drops like a dead weight. You’ve just witnessed a positive Drop Arm Test—a finding that changes your entire clinical reasoning.
What is the Drop Arm Test?
The Drop Arm Test (also called Codman’s test) is a special test used to assess the integrity of the supraspinatus tendon and the deltoid muscle. It’s designed to detect a full-thickness rotator cuff tear, specifically when the patient cannot control the arm eccentrically during the lowering phase. The test relies on the principle that the supraspinatus is a primary initiator of abduction and a key stabilizer during the first 30 degrees of movement.
Why the Drop Arm Test Matters in Physical Therapy Practice
This test is a critical red flag in your shoulder evaluation. A positive test is highly suggestive of a massive or full-thickness tear of the supraspinatus, which often requires a surgical consult. For your Plan of Care (POC), this finding shifts your approach from aggressive strengthening to protecting the tissue, managing pain, and educating the patient on activity modification while they await further imaging or a physician referral.
What You’ll See in the Clinic
The patient typically presents with significant weakness and pain with shoulder abduction. The hallmark sign is the inability to smoothly lower the arm from a fully elevated position. Instead of a controlled descent, the arm drops suddenly to the side.
“Patient is status-post fall onto an outstretched arm. AROM is 0-170 degrees with pain, but during the lowering phase, the patient loses control at 90 degrees and the arm drops to the side. Drop Arm Test is positive. I will educate the patient on a shoulder sling for comfort and initiate PROM and pendulum exercises, while coordinating a referral to orthopedics for an MRI.”
Common Pitfall & Pro Tip
⚠️ Pitfall: Assuming a negative test rules out a tear. This test is highly specific for full-thickness tears; it will be negative in cases of partial tears or tendinopathy. Don’t rely on it as your only screening tool.
💡 Pro Tip: To differentiate between true weakness and pain inhibition, ask the patient to lower the arm very slowly. If they can hold it isometrically but have pain, it suggests a different pathology. A true positive test is an inability to control the weight, not just pain.
Memory Aid for the Drop Arm Test
Think “The Elevator Cable”: The supraspinatus is the elevator cable that controls the descent of the “elevator car” (your arm). If the cable snaps, the car plummets to the ground. A positive test means the cable is compromised.
NPTE Connection
Expect this to appear in exam items asking you to identify the pathology based on a clinical scenario, or to select the most appropriate special test for a suspected rotator cuff tear. It’s a classic test for the musculoskeletal section.
Related Physical Therapy Concepts
This test directly connects to other rotator cuff special tests like the Empty Can Test and the Full Can Test, which are used to isolate supraspinatus strength. Understanding the rotator cuff as a dynamic stabilizer is key, and you’ll often pair this assessment with impingement tests to rule out subacromial bursitis or other causes of shoulder pain.
Quick Reference
✓ Positive test criteria: Inability to smoothly lower arm from elevation; arm drops to side ✓ Priority level: High – Indicates need for further imaging and potential surgical consult ✓ PT Interventions/Considerations: • Protect the shoulder with a sling if needed • Initiate passive range of motion (PROM) to maintain mobility • Educate on activity modification and avoiding lifting • Refer to physician for MRI/X-ray • Begin isometric strengthening once cleared by physician
Bottom line: A positive Drop Arm Test is a pivotal moment that separates conservative management from a surgical pathway.