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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Other common orthopedic tests to assess the subscapularis are the Bear Hug Test and the Lift-Off Sign.

References

Pennock, A. T., Pennington, W. W., Torry, M. R., Decker, M. J., Vaishnav, S. B., Provencher, M. T., … & Hackett, T. R. (2011). The influence of arm and shoulder position on the bear-hug, belly-press, and lift-off tests: an electromyographic study. The American journal of sports medicine, 39(11), 2338-2346.

Kappe, T., Sgroi, M., Reichel, H., & Daexle, M. (2018). Diagnostic performance of clinical tests for subscapularis tendon tears. Knee Surgery, Sports Traumatology, Arthroscopy, 26(1), 176-181.

Takeda, Y., Fujii, K., Miyatake, K., Kawasaki, Y., Nakayama, T., & Sugiura, K. (2016). Diagnostic value of the supine Napoleon test for subscapularis tendon lesions. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 32(12), 2459-2465.

Barth, J. R., Burkhart, S. S., & De Beer, J. F. (2006). The bear-hug test: a new and sensitive test for diagnosing a subscapularis tear. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 22(10), 1076-1084.

Yoon, J. P., Chung, S. W., Kim, S. H., & Oh, J. H. (2013). Diagnostic value of four clinical tests for the evaluation of subscapularis integrity. Journal of Shoulder and Elbow Surgery, 22(9), 1186-1192.

Schiefer, M., Ching-San Júnior, Y. A., Silva, S. M., Fontenelle, C., Carvalho, M. G. D., de Faria, F. G., & Franco, J. S. (2012). Clinical diagnosis of subscapularis tendon tear using the bear hug semiological maneuver. Revista Brasileira de Ortopedia (English Edition), 47(5), 588-592.