The Influence of Arm and Shoulder Position on the Bear-Hug, Belly-Press, and Lift-Off Tests

Authors:

Andrew T Pennock, W Wesley Pennington, Michael R Torry, Michael J Decker, Suketu B Vaishnav, Matthew T Provencher, Peter J Millett, Thomas R Hackett

Abstract:

Rotator cuff tears are a frequent and debilitating cause of shoulder disability. While the majority of rotator cuff tears involve the supraspinatus and infraspinatus muscles, an increased awareness and recognition of subscapularis tears has led to further investigations into the causes, diagnosis, and treatment of this entity. Acting as the largest and most powerful of the rotator cuff muscles, the subscapularis functions as the primary internal rotator of the humerus and stabilizes the humeral head in the glenoid cavity by resisting anterior, posterior, and inferior displacement. Injury or weakness to the subscapularis may lead to an increased incidence of impingement and/or anterior instability during humeral elevation, abduction, and external rotation. As such, it is important for clinicians to be able to properly identify, diagnose, and treat injuries of the subscapularis muscle.

The belly-press, lift-off, and bear-hug tests were all developed to identify subscapularis muscle injuries. Validated by Gerber the belly-press and lift-off tests are the most common physical examinations used to clinically detect subscapularis tears. More recent in its conception, the bear-hug test was introduced by Barth. While each test has been accepted as a reliable method to isolate the subscapularis muscle, significant variability exists among physicians in terms of how to perform each test. Moreover, patient factors including pain and shoulder stiffness can affect the clinical administration of these tests.

No study to date has examined the optimal arm or shoulder position during the execution of these tests, and it is unclear whether the means by which these tests are conducted may affect the integrity of the tests. Faulty arm position could theoretically yield results that are inconsistent with the true injury. Therefore, the purpose of this study was to utilize electromyography (EMG) to (1) determine the optimal arm and shoulder position for evaluating subscapularis function within the belly-press, lift-off, and bear-hug tests and (2) compare the efficacy of each clinical test in the isolation of the subscapularis muscle. Our hypothesis was that there would be no difference in subscapularis muscle activity when the arm is placed in varying positions for testing.

For the complete study: The Influence of Arm and Shoulder Position on the Bear-Hug, Belly-Press, and Lift-Off Tests

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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The Influence of Arm and Shoulder Position on the Bear-Hug, Belly-Press, and Lift-Off Tests

Authors:

Abstract:

About the Author: Peter Millett, MD