Bear Hug Test

Original Editor - Lilian Ashraf
Top Contributors - Lilian Ashraf and Kim Jackson

Purpose

The subscapularis muscle forms a major part of the rotator cuff, it provides 50% of the strength of the rotator cuff and forms the anterior part of the force couples of the glenohumeral joint.[1]

The bear hug test is used to test for subscapularis muscle tear or dysfunction.[2]

Technique

The patient places the palm of the affected side on the opposite shoulder, with the fingers extended and the elbow anterior to the body. The patient is asked to maintain the arm position. The therapist then applies an external rotation resisting force perpendicular on the patient’s forearm, the patient resists the therapist by performing internal rotation.

The test is positive if the patient could not maintain the position of the hand against the shoulder or showed weakness in resisted internal rotation greater than 20% compared to the opposite side.[2]

[3]


Evidence

The bear hug test sensitivity is 0.52 and specificity is 0.85.[4]

In 2017 Thomas Kappe el al, studied the diagnostic performance of clinical tests for subscapularis tendon tears, the conclusion was that the bear hug test  have the highest sensitivity of all tests studied including the lift-off test, internal rotation lag sign, belly press test and belly off sign.[4] 

A study by Jong Pil Yoon MD et al in 2013, found the belly-press test to be more sensitive than the bear hug test which could be explained due to combined pathologies as impingement symptoms, superior labrum anteroposterior tears or tendinopathy which could have influenced the bear hug test results at 90 degrees shoulder flexion. It also found the bear hug test to be useful for prediction of internal rotation strength deficit and for discrimination of impaired internal rotation strength.[5][1]

A study by Barth JR et al, in 2006 found that the bear hug test to be the most sensitive test for the subscapularis muscle compared to the lift-off, belly-press and Napoleon tests.[2]

A positive bear hug test and belly press test suggest tear of at least 30% of the subscapularis, positive Napoleon test suggest a tear of greater than 50% and a positive life off test indicate that at least 75% of the subscapularis is torn.[2]

Clinical Bottom Line

It is advised to do more than one subscapularis test to increase the sensitivity. Subscapularis tears maybe hard to recognize so a high level of suspension has to be maintained.[4]

References

  1. 1.0 1.1 Lin L, Yan H, Xiao J, Ao Y, Cui G. Internal rotation resistance test at abduction and external rotation: a new clinical test for diagnosing subscapularis lesions. Knee Surgery, Sports Traumatology, Arthroscopy. 2015 Apr 1;23(4):1247-52.
  2. 2.0 2.1 2.2 2.3 Barth JR, Burkhart SS, De Beer JF. The bear-hug test: a new and sensitive test for diagnosing a subscapularis tear. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2006 Oct 1;22(10):1076-84.
  3. CRTechnologies. Bear Hug Test. Available from: https://www.youtube.com/watch?v=b-dt3Hy4vD4 [last accessed 11/1/2021]
  4. 4.0 4.1 4.2 Kappe T, Sgroi M, Reichel H, Daexle M. Diagnostic performance of clinical tests for subscapularis tendon tears. Knee Surgery, Sports Traumatology, Arthroscopy. 2018 Jan 1;26(1):176-81.
  5. Yoon JP, Chung SW, Kim SH, Oh JH. Diagnostic value of four clinical tests for the evaluation of subscapularis integrity. Journal of Shoulder and Elbow Surgery. 2013 Sep 1;22(9):1186-92.