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The external rotation lag sign for rotator cuff tears The patient is positioned at an examination couch facing away from you You gently bend the elbow to about 90 degrees while the shoulder is slightly elevated at around 20 degrees in the scapular plane positioned in full external rotation Then you slightly reduce the range about 5 degrees to prevent false positives due to elastic recoil You instruct the patient to actively hold the external rotation while you release the wrist providing only su