Positive Shrug test indicates?

• A. The patient cannot reach 90° abduction without elevating the shoulder girdle
• B. The patient cannot abduct beyond 45°
• C. The patient experiences pain with abduction
• D. The patient cannot reach 90° abduction without elevating the shoulder girdle

Answer: (D)

Overhead arm abduction relies on upward rotation of the scapula driven by the coordinated action of the trapezius and serratus anterior. If the trapezius is weak (as in spinal accessory nerve palsy), this upward rotation is compromised. When a patient tries to abduct the arm to about 90 degrees, they must compensate by shrugging or lifting the shoulder girdle to force the scapula into a position that permits further elevation. A positive shrug test is observed when the patient cannot reach 90 degrees of abduction without this compensatory shoulder girdle elevation, indicating trapezius weakness. This helps distinguish trapezius/spinal accessory nerve problems from other causes of shoulder abduction limitation.