Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original articleThe Bear-Hug Test: A New and Sensitive Test for Diagnosing a Subscapularis Tear
Section snippets
Methods
The junior author (J.R.H.B.) undertook a prospective study involving all of the patients scheduled to undergo an arthroscopic procedure by one of the senior authors (S.S.B.) during a period of 3 months (from January 2004 to March 2004). Previously operative shoulders and stiff shoulders scheduled for a capsular release and lysis of adhesions were excluded from the study group. After exclusion of these patients, the study group comprised 68 shoulders. The mean age of the patients was 45.1 ± 14.7
Results
During diagnostic arthroscopy, we found 34 torn rotator cuffs, including 20 subscapularis tears (5 isolated subscapularis tears), 19 SLAP lesions, 4 anterior Bankart lesions, 4 posterior Bankart lesions, and 19 cases of pathologic biceps (13 requiring biceps tenodesis, 3 requiring biceps tenotomy, 1 requiring biceps debridement, and 2 that had chronic complete ruptures). The prevalence rate of subscapularis tears in our study group was 29.4% (20 of 68). A pathologic biceps was found in 14
Discussion
Of the 34 torn rotator cuffs in this study, 20 had a subscapularis tear (58.8%). The prevalence of subscapularis tears in this study (29.4%) was much greater than that reported in some previous studies in the literature (3.5% reported by Codman8 and 4% reported by Deutsch et al.9). This discrepancy deserves an explanation. The aforementioned studies were both clinical studies, with subscapularis tears being discovered at the time of open surgery. In contrast, an anatomic cadaveric study by
Conclusions
The bear-hug test is the most sensitive clinical test for subscapularis function. Clinical examination should include the lift-off test, belly-press test, Napoleon test, and bear-hug test to optimize the chance of detecting and predicting the size of a subscapularis tear. Positive bear-hug and belly-press tests suggest a tear of at least 30% of the subscapularis, whereas a positive Napoleon test indicates that greater than 50% of the subscapularis is torn. Furthermore, a positive lift-off test
Acknowledgment
The authors thank John D. Schoolfield, M.S., for his assistance with the statistical and data analysis in this study.
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