Execution
- 1Position the patient standing or sitting and place the test arm behind the back in internal rotation.
- 2Passively lift the dorsum of the hand away from the lumbar spine into maximal available internal rotation.
- 3Ask the patient to maintain the lifted hand position.
- 4Release the hand while guarding the arm.
- 5Observe whether the hand springs back toward the back and estimates the lag.
Positive outcome
The test is positive if the patient cannot hold the internally rotated position and the hand springs back toward the lumbar spine. Magee notes that even a small lag between passive and active internal rotation can suggest partial subscapularis tear, while a larger spring-back suggests more substantial subscapularis failure.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Hertel et al. (1996) | NA | NA | NA | NA | NA |
| Jain et al. (2017) | NA | NA | NA | NA | NA |
CommentThis is a high-specificity subscapularis sign when clearly positive, but available diagnostic tables vary by tear definition and reference standard. The test requires enough shoulder internal-rotation range to assume the behind-back position; if the patient cannot get there, belly-press or bear-hug testing is more appropriate. Do not interpret failure caused by stiffness as a pure subscapularis tear sign.
Moderate Clinical Value