Dugas’ sign is a clinical indicator of shoulder dislocation, most often anterior dislocation. A positive sign is present when the patient is unable to place the hand of the affected side on the opposite shoulder and move the elbow to touch the chest.

Pathophysiology

• In normal shoulder mechanics, the humeral head sits properly in the glenoid fossa, allowing full adduction and internal rotation so the elbow can approximate the chest.

• In shoulder dislocation, especially anterior dislocation, the humeral head is displaced, producing:

  • Mechanical restriction of adduction and internal rotation.

  • Severe pain on attempted movement.

  • Muscle spasm preventing completion of the maneuver.

Examination Technique

Patient Positioning

• Seat or stand the patient comfortably.

• Support the arm to reduce pain during testing.

Maneuver

1. Ask the patient to place the hand of the affected arm on the opposite shoulder.

2. Then instruct the patient to move the elbow forward and inward toward the chest.

Positive Test

• Inability to perform the maneuver due to pain, mechanical block, or limitation confirms a positive Dugas’ sign.

Clinical Utility

• Quick bedside test for suspected shoulder dislocation.

• Helps differentiate between:

  • Dislocation → positive sign.

  • Other shoulder pathology (e.g., rotator cuff tear, bursitis, frozen shoulder) → maneuver may still be possible, though painful.

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Differential Diagnosis (Other Conditions Causing Difficulty with the Maneuver)

Pediatric considerations

• Rare, as children more often present with clavicle fractures than dislocations.

• Always rule out fracture before attempting the maneuver.

Geriatric considerations

• In older adults, a positive sign may coexist with rotator cuff injury or degenerative joint disease.

• Gentle technique required to avoid worsening injury.

Limitations

• Not specific for dislocation—severe pain or stiffness from other shoulder conditions may prevent performance.

• Should be followed by X-ray or ultrasound to confirm diagnosis.

Patient counseling

• Explain that inability to perform this arm movement suggests the shoulder joint is out of place (dislocated).

• Reassure that imaging and treatment (reduction, immobilization, physiotherapy) are needed to restore function.

Conclusion

Dugas’ sign is a simple, reliable clinical test for detecting shoulder dislocation, particularly anterior dislocation. Though highly suggestive, it must be confirmed by imaging to exclude fractures or other shoulder injuries.

References

1. Dugas L. A new sign for the recognition of dislocation of the shoulder. Med News. 1872;21:164–165.

2. Rockwood CA, Matsen FA, Wirth MA, Lippitt SB. The Shoulder. 5th ed. Elsevier; 2017.

3. Hoppenfeld S, deBoer P. Surgical Exposures in Orthopaedics. 5th ed. Wolters Kluwer; 2017.

4. Sammarco GJ, et al. Clinical signs of shoulder dislocation. J Bone Joint Surg Am. 1983;65(4):458–461.