Clinical Tests That Can Be Used to Evaluate a Patient with an Isolated Rupture of the Tendon of the Subscapularis Muscle

 

Bear Hug Test

Starting Position: The palm of the arm for the affected shoulder is placed on the opposite shoulder with fingers extended and elbow at shoulder level.

Normal (“Negative”): The person can hold the palm in position against an upward, external rotation to the hand done by the examiner.

Abnormal (“Positive”): The person cannot hold the hand in place.

 

Belly Off

Starting Position:The examiner places the palm of the hand of the affected shoulder on the abdomen with the elbow anterior and the wrist not flexed (similar to the belly press test, below except the person is not instructed to press against the abdomen).

Normal (“Negative”): The patient can maintain the position with the palm of the hand against the abdomen.

Abnormal (“Positive”): The patient cannot maintain the position and the palm comes off the abdomen.

 

Belly Press (“Napoleon”)

Starting Position: The person places the palm of the arm to the affected on the abdomen at the level of the umbilicus and presses against the stomach.

Normal (“Negative”): The elbow is anterior to the ears and the wrist is not flexed.

Abnormal (“Positive”): The elbow is rotated behind the body and the wrist is flexed.

 

where:

• The belly press test is called the “Napoleon” because of its resemblance to the famous pose of General Buonoparte.

 

External Rotation (Figure 2, Gerber and Krushell)

Starting Position: The elbow is bent to 90°, the fingers extended and the upper arm vertical.

Normal (“Negative”): The upper extremity can be rotated anteriorly.

Abnormal (“Positive”): Rotating the upper extremity is painful and the hand ends up pointing laterally .

 

Posterior Lift-off

Starting Position: The hand of the arm of the affected shoulder is placed several inches from the the mid-back with the palm outwards.

Normal (“Negative”): The person is able to maintain it in position.

Abnormal (“Positive”): The person cannot maintain the hand in place. The hand drops onto the back and cannot be lifted off by the patient.