Execution
- 1Position the patient standing.
- 2Ask the patient to place the dorsum of the test hand on the back pocket or against the midlumbar spine.
- 3Ask the patient to lift the hand away from the back.
- 4If the patient can lift the hand, examiner applies resistance by pushing the hand toward the back.
- 5Observe hand lift-off strength and scapular motion during the resisted effort.
Positive outcome
Inability to lift the hand away from the back is positive for subscapularis lesion. Weakness against resistance is also abnormal. Magee notes that abnormal scapular motion during the test may indicate scapular instability rather than isolated subscapularis failure.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Gerber & Krushell (1991) | NA | NA | NA | NA | NA |
| Barth et al. (2006) | NA | 17.6 | 100 | infinity | 0.82 |
| Hertel et al. (1996) | NA | NA | NA | NA | NA |
CommentLift-off is highly specific when clearly positive, but it misses many subscapularis tears because patients need enough internal rotation range to assume the start position. The infinite LR+ from 100% specificity should be read as a small-sample artefact, not a stable multiplier. Belly-press or bear-hug may be preferable when behind-back positioning is limited.
High Clinical Value