This systematic review and meta-analysis pooled the diagnostic accuracy of physical exam tests for subscapularis tears. It screened 2212 records and analyzed 13 studies covering 8 named tests, with four eligible for meta-analysis. The question: can any single clinical test reliably diagnose a subscapularis tear?
When you examine a shoulder and suspect a subscapularis tear, treat these tests as rule-in, not rule-out. A positive bear-hug, belly-press, lift-off, or IRLS strongly supports a tear because specificity exceeds 0.90.
But a negative exam means little. Sensitivity under 0.60 across every test means you will miss a large share of tears on clinical exam alone, which is why the authors conclude imaging remains necessary.
Know the maneuvers for boards: the lift-off is the original Gerber test, the IRLS is its passive version, and the belly-press and Napoleon variants are useful when pain or stiffness blocks the lift-off. The bear-hug is the newest and best single test.
Apply pretest probability. In a surgical cuff-disease population where prevalence is 34%, a positive test carries more weight than in a general shoulder-pain clinic where prevalence is 15%.
This systematic review and meta-analysis pooled the diagnostic accuracy of physical exam tests for subscapularis tears. It screened 2212 records and analyzed 13 studies covering 8 named tests, with four eligible for meta-analysis. The question: can any single clinical test reliably diagnose a subscapularis tear?
When you examine a shoulder and suspect a subscapularis tear, treat these tests as rule-in, not rule-out. A positive bear-hug, belly-press, lift-off, or IRLS strongly supports a tear because specificity exceeds 0.90.
But a negative exam means little. Sensitivity under 0.60 across every test means you will miss a large share of tears on clinical exam alone, which is why the authors conclude imaging remains necessary.
Know the maneuvers for boards: the lift-off is the original Gerber test, the IRLS is its passive version, and the belly-press and Napoleon variants are useful when pain or stiffness blocks the lift-off. The bear-hug is the newest and best single test.
Apply pretest probability. In a surgical cuff-disease population where prevalence is 34%, a positive test carries more weight than in a general shoulder-pain clinic where prevalence is 15%.