Execution
- 1Position the patient standing.
- 2Ask the patient to place the hand of the test shoulder on top of the opposite shoulder with the fingers extended.
- 3Keep the patient's elbow in front of the body and stabilize it with one hand.
- 4Try to lift the patient's hand away from the shoulder by applying an external-rotation force.
- 5Ask the patient to resist and keep the hand on the opposite shoulder.
Positive outcome
The test is positive when the patient cannot keep the hand on the opposite shoulder because of weakness. Magee describes this as positive for subscapularis strain or tear.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Barth et al. (2006) | NA | 60 | 91.7 | 7.23 | 0.44 |
| Jain et al. (2017) | NA | NA | NA | NA | NA |
CommentBarth introduced the bear-hug test as more sensitive than belly-press, Napoleon, or lift-off for subscapularis tears, but sensitivity is still not high enough for screening. The test is more useful when clearly positive than when negative. Larger and more recent cohorts show that subscapularis tests tend to have high specificity but low sensitivity.
Moderate Clinical Value