Reliability of forced internal rotation and active internal rotation to assess lateral instability of the biceps pulley

Paolo Arrigoni, Giacomo Delle Rose, Riccardo D'Ambrosi, Giorgio Rotundo, Vincenzo Campagna, Piergiorgio Pirani, Manlio Panascì, Dario Petriccioli, Celeste Bertone, Andrea Grasso, Carmine Latte, Alberto Costa, Gino Viola, Silvana De Giorgi, Antonello Panella, Roberto Padua, Alessandro Beccarini, Barbara Salcher, Matteo Olivieri, Marco MugnainiAntonello Pannone, Chiara Ceoldo, Umile Giuseppe Longo, Vincenzo Denaro, Simone Cerciello, Alfredo Schiavone Panni, Paolo Avanzi, Claudio Zorzi, Vincenza Ragone, Alessandro Castagna, Pietro Randelli

Research output: Contribution to journalArticlepeer-review


Purpose: the aim of this study was to investigate the relationship between positive painful forced internal rotation (FIR) and lateral pulley instability in the presence of a pre-diagnosed posterosuperior cuff tear. The same investigation was conducted for painful active internal rotation (AIR). Methods: a multicenter prospective study was conducted in a series of patients scheduled to undergo arthroscopic posterosuperior cuff repair. Pain was assessed using a visual analog scale (VAS) and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) was administered. The VAS score at rest, DASH score, and presence/absence of pain on FIR and AIR were recorded and their relationships with lesions of the lateral pulley, cuff tear patterns and shape of lesions were analyzed. Results: the study population consisted of 115 patients (mean age: 55.1 years) recruited from 12 centers. The dominant arm was affected in 72 cases (62.6%). The average anteroposterior extension of the lesion was 1.61 cm. The mean preoperative VAS and DASH scores were 6.1 and 41.8, respectively. FIR and AIR were positive in 94 (81.7%) and 85 (73.9%) cases, respectively. The lateral pulley was compromised in 50 cases (43.4%). Cuff tears were partial articular in 35 patients (30.4%), complete in 61 (53%), and partial bursal in 19 (16.5%). No statistical correlation between positive FIR or AIR and lateral pulley lesions was detected. Positive FIR and AIR were statistically associated with complete lesions. Negative FIR was associated with the presence of partial articular tears. Conclusions: painful FIR in the presence of a posterosuperior cuff tear does not indicate lateral pulley instability. When a cuff tear is suspected, positive FIR and AIR are suggestive of full-thickness tear patterns while a negative FIR suggests a partial articular lesion. Level of evidence: level I, validating cohort study with good reference standards.

Original languageEnglish
Pages (from-to)20-24
Number of pages5
Issue number1
Publication statusPublished - Jan 1 2015


  • Biceps pulley
  • Clinical test
  • Diagnostic accuracy
  • Internal rotation
  • Shoulder arthroscopy

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Rehabilitation
  • Surgery


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