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Subscapularis Physical Exam

Lift Off Test

 

Lift Off Test

  • Place the patients arm behind the back in the midline at the waist. Patient is instructed to raise the hand off the back.
  • Positive result = inability to raise hand off the back. Only positive if >75% of subscapularis is torn (Barth JRH, Arthroscopy 2006;22:1076).
  • Indicates: subscapularis tear.
  • (Gerber C, JBJS 1991;73B:389).
  • (Greis, PE, AJSM 1996;24:589).

 

Abdominal Compression Test

Abdominal Compression Test

  • synonym: Belly-press test.
  • The patients hand is place flat on their abdomen with the hand, wrist and elbow in a straight line. The patient is then instructed to press down on the abdomin.
  • Postive Result: An inability to compresses the abdomen without flexing at the wrist
  • Indicates: subscapularis tear.
  • (Burkhart SS, Arthroscopy 2002;18:454), (Gerber C, JBJS 1996;78:1015).
Bear Hug Test

Bear Hug Test

  • The patients hand is placed on the opposite shoulder with the elbow anterior to the body. The examiner then applies an ER force while the patient attempts to maintain the hand on the shoulder
  • Postive Result: Patient cannot hold the hand against the shoulder as examiner applies an ER force.
  • Indicates: subscapularis tear.
  • (Barth JRH, Arthroscopy 2006;22:1076)

Roll over image to see negative exam

Napoleon Test

Napoleon Test

  • Similar to Abdominal compression test.
  • The patients hand is placed flat on their abdomen with the hand, wrist and elbow in a straight line. The patient is then instructed to press down on the abdomen. Negative result = wrist remains at 0° while pressing on belly, indicates normal subscapularis function.
  • Postive Result: patient can press on the
    belly only by flexing the wrist 90°; Intermediate result = wrist flexed 30° to 60° indicates partial function of subscapularis.
  • Indicates: subscapularis tear.
  • (Burkhart SS, Arthroscopy 2002;18:454)

Roll over image to see negative exam

Belly-Off Sign Belly-Off Sign
  • The patients arm is placed in flexion and maximum IR with the elbow flexed 90º. The examiner holds the elbow while positioning the hand on the abdomen. The patient is instructed to maintain the position with the wrist straight while the examiner lets go of the hand.
  • Postive Result: patient's hand lifts off the abdomen when the examiner lets go.
  • Indicates: subscapularis tear.
  • (Scheibel M, Arthroscopy 2005;21:1229)

Roll over image to see initial positioning

   

 

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