The examiners places the patient’s forearm on the abdomen with the elbow flexed and the arm maximally internally rotated.
The examiner’s hand is placed between the patient’s hand and abdomen so that the strength of the subsequent pressure can be felt.
The patient is now requested to press the arm forcefully against the abdomen while holding the elbow forward.
What does a positive Belly Press Test mean?
Belly Press Test is positive if the strength of the subscapularis is impaired, maximal internal rotation cannot be maintained, the patient feels weakness, and the elbow deviates laterally and posteriorly under the influence of the latissimus dorsi and teres major muscles, he also tends to flex the wrist to press against the abdomen
Sensitivity & Specificity
A study by Márcio Schiefer1 for clinical diagnosis of subscapularis tendon tears, he found that the Belly press test gave the greatest specificity but low Sensitivity:
In this test, the examiner lays the patient’s arm passively on the abdomen in a fully flexed and internally rotated position with the wrist extended. The examiner asks the patient to hold this position.
The belly off test is positive if the patient cannot hold the position, and the hand slips away from the abdomen. In the case of an isolated partial subscapularis tendon tear, this test is usually positive as a result of the preponderance of externally rotating forces.
Márcio Schiefer,Yonder Archanjo Ching-San Júnior, Sérgio Maurício Silva, César Fontenelle, Marcos Genúncio Dias Carvalho, Fabio Garcia de Faria, and José Sérgio Franco: CLINICAL DIAGNOSIS OF SUBSCAPULARIS TENDON TEAR USING THE BEAR HUG SEMIOLOGICAL MANEUVER. Rev Bras Ortop. 2012 Sep-Oct; 47(5): 588–592. PMID: 27047870.
Gerber C, Krushell RJ: Isolated rupture of the tendon of the subscapularis muscle: clinical features in 16 cases. J Bone Joint Surg 73B:389–394, 1991.
Scheibel M, Magosch P, Pritsch M, Lichtenberg S, Habermeyer P. The belly-off sign: a new clinical diagnostic sign for subscapularis lesions. Arthroscopy. 2005 Oct;21(10):1229-35. doi: 10.1016/j.arthro.2005.06.021. PMID: 16226652.
Clinical Tests for the Musculoskeletal System 3rd Edition.
Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.