Fractures and dislocations: Hornblower sign: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Fractures and dislocations: Hornblower sign

Sample item

With the arm abducted to 90 degrees and the elbow flexed, a patient with a massive posterosuperior rotator cuff tear cannot hold external rotation and the hand falls towards the mouth like a bugler. Which muscle is mainly implicated by this Hornblower sign?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Teres minor

The Hornblower sign indicates a deficient teres minor, which is the main external rotator in abduction. It is seen with massive cuff tears extending posteriorly and may signal poor results from some repairs and the need for a tendon transfer or reverse arthroplasty.

Option by option

  • A. Deltoid

    The deltoid abducts the arm and is supplied by the axillary nerve, which is intact in this tear.

  • B. Subscapularis

    Subscapularis is an internal rotator and is tested by lift-off and belly-press.

  • C. Supraspinatus

    Supraspinatus initiates abduction and is tested by the empty can test.

  • D. Teres minor (correct)

    Correct. Loss of external rotation in abduction reflects teres minor deficiency.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is D, Teres minor. The Hornblower sign indicates a deficient teres minor, which is the main external rotator in abduction.

Why is "Deltoid" not the answer?

The deltoid abducts the arm and is supplied by the axillary nerve, which is intact in this tear.

Why is "Subscapularis" not the answer?

Subscapularis is an internal rotator and is tested by lift-off and belly-press.

Why is "Supraspinatus" not the answer?

Supraspinatus initiates abduction and is tested by the empty can test.

What concept does this question test?

It tests Fractures and dislocations: Hornblower sign in Orthopaedics. It is seen with massive cuff tears extending posteriorly and may signal poor results from some repairs and the need for a tendon transfer or reverse arthroplasty.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Fractures and dislocations: Hornblower sign?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.