This Level I diagnostic study introduces the bear-hug test for subscapularis tears. It compares the new test against the lift-off, belly-press, and Napoleon tests in 68 consecutive arthroscopy patients. Arthroscopy served as the reference standard for confirming and sizing each tear.
When you examine a shoulder for cuff pathology, the bear-hug test is your most sensitive screen for the subscapularis. Position the palm on the opposite shoulder, elbow held forward, and resist as the patient holds; weakness over 20% versus the other side is positive.
The key mental model is anatomic. The lift-off recruits the lower subscapularis and stays negative until 75% of the tendon is gone, so it misses partial upper-third tears. The bear-hug and belly-press load the upper fibers and turn positive at just 30%. Because all four tests are highly specific but poorly sensitive, a positive test confirms a tear while a negative exam never excludes one.
Remember the biceps link: 70% of these tears had biceps pathology, so a subluxed or torn biceps should trigger a hunt for a hidden subscapularis lesion at arthroscopy.
This Level I diagnostic study introduces the bear-hug test for subscapularis tears. It compares the new test against the lift-off, belly-press, and Napoleon tests in 68 consecutive arthroscopy patients. Arthroscopy served as the reference standard for confirming and sizing each tear.
When you examine a shoulder for cuff pathology, the bear-hug test is your most sensitive screen for the subscapularis. Position the palm on the opposite shoulder, elbow held forward, and resist as the patient holds; weakness over 20% versus the other side is positive.
The key mental model is anatomic. The lift-off recruits the lower subscapularis and stays negative until 75% of the tendon is gone, so it misses partial upper-third tears. The bear-hug and belly-press load the upper fibers and turn positive at just 30%. Because all four tests are highly specific but poorly sensitive, a positive test confirms a tear while a negative exam never excludes one.
Remember the biceps link: 70% of these tears had biceps pathology, so a subluxed or torn biceps should trigger a hunt for a hidden subscapularis lesion at arthroscopy.