The patient is placed in an upright standing position,
The patient places the palm of the hand of the affected side on the opposite shoulder with outstretched fingers and the elbow pointing forward (anteriorly to the body),
While the patient tries to hold this position by actively internally rotating, the examiner grasps the patient’s wrist and tries to loosen the hand from the shoulder by forcibly externally rotating the arm , pulling at right angles to the forearm to remove his hand from his shoulder.
The test should be compared with the other side.
What does a positive Bear Hug Test mean?
If there is a tear of the subscapularis tendon, especially of the upper part, the patient is unable to maintain the hold on the opposite shoulder (a positive Bear Hug Test).
Pain and muscle weakness in comparison with the other side suggests subscapularis tendon dysfunction (the resistance is 20% less than that of the contralateral side).
Grading of the Bear Hug test:
Normal: absence of pain and grade 5 muscle strength
Intermediate: pain and grade 5 muscle strength
Positive: grade 4 muscle strength
Sensitivity & Specificity
The bear-hug test optimizes the chance of detecting a tear of the upper part of the subscapularis tendon. Moreover, because the bear hug test represents the most sensitive test, it can be considered to be the most likely clinical test to alert the surgeon to a possible subscapularis tear.
Sensitivity: 60 %
Performing all of the subscapularis tests is useful in predicting the size of the tear.
Another study by Márcio Schiefer 2 to evaluate the Bear Hug maneuver for clinically diagnosing subscapularis tendon tears, and compare it with other maneuvers (Lift-off test, Napoleon test and Belly Press test). The Sensitivity was (75 %) while the Specificity was (56 %) and accuracy was (65 %).
Barth JR, Burkhart SS, De Beer JF. The bear-hug test: a new and sensitive test for diagnosing a subscapularis tear. Arthroscopy. 2006 Oct;22(10):1076-84. doi: 10.1016/j.arthro.2006.05.005. PMID: 17027405.