Bear Hug Test | Subscapularis Weakness | Subscapularis Tear Assessment
The Bear Hug is an easy way to assess strength and pain in the subscapularis. According to an EMG study done by Pennock et al. (2011), the Bear Hug activated the subscapularis to the same degree as the belly press and lift-off test, while minimizing pectoralis, lat and teres major action, which are more active in resisted internal rotation in the zero position.
Different studies have evaluated the Bear Hug test and have found a varying sensitivity from 19.1% to 75% and a specificity ranging from 56% to 99%. You can find all individual studies in the references down below. Across all of the studies, the sensitivity was rather weak and the specificity values were moderate to high, which makes the test moderately useful to confirm a subscapularis tendon tear in practice.
To perform the test, have the patient stand and ask him to put the palm of the involved side on top of his contralateral shoulder with his fingers extended and the elbow positioned anterior to the body. Then the patient tries to hold the starting position by means of resisted internal rotation as the examiner tries to pull the patient’s hand from the shoulder with an external rotation force applied perpendicular to the forearm.
This test is positive, if the patient is not able to keep his hand on his contralateral shoulder or if the patient reports recognizable shoulder pain.
21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE
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