Belly Press | Subscapularis Tear | Shoulder Assessment

The belly press is an easy test to assess strength and pain in the subscapularis.According to an EMG study done by Pennock et al. in the year 2011, the belly press activated the subscapularis to the same degree as the bear hug and lift-off test, while minimizing pectoralis, lat, and teres major action.

According to Jain et al. (2017) the Belly Press has a sensitivity of 28% and a specificity of 87% in the detection of MRI confirmed subscapularis tears. This means that this test has only weak clinical value due to its low accuracy.

To perform the test, put your backhand against your patient’s belly and ask him to press against your hand. This test is positive, if you detect weakness compared to the other side, or if your patient reports pain. An even better way to measure your patient’s subscapularis strength is to put a blood pressure cuff between your patient’s hand and his belly so that you have a quantitative number of his internal rotation strength. Besides the advantage of a quantitative measure, the belly press is easily performed in patients with little range of motion or for whom the hand behind the back or shoulder elevated to 90 degrees is provocative.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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Other tests to assess for subscapularis tears in the shoulder are:

• Bear Hug Test
• Lift Off Sign

References

Pennock AT, Pennington WW, Torry MR, Decker MJ, Vaishnav SB, Provencher MT, Millett PJ, Hackett TR. 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. 2011 Nov;39(11):2338-46.

Jain NB, Luz J, Higgins LD, Dong Y, Warner JJ, Matzkin E, Katz JN. The diagnostic accuracy of special tests for rotator cuff tear: the ROW cohort study. American journal of physical medicine & rehabilitation. 2017 Mar;96(3):176.