The Bear Hug Test Improves Sensitivity Compared With the Belly Press Test for Identifying Subscapularis Tendon Tears, but Both Tests Miss the Majority of Partial Tears

Abstract

Purpose: To investigate the performance of the bear hug (BH) and belly press (BP) tests in diagnosing tears of the subscapularis (SSC). Methods: A retrospective review was conducted on prospectively maintained data on patients who underwent arthroscopic rotator cuff repair (ARCR) of SSC tears between 2011 and 2021. A control group also was obtained of ARCRs with an intact SSC tendon. All examinations and ARCRs were performed by one high-volume shoulder surgeon. The BH test and BP test results were compared with arthroscopic findings as the gold-standard diagnostic modality. Tear type was classified based on the Lafosse classification. Sensitivity, specificity, positive and negative predictive values, false-positive and false-negative rates, and accuracy were calculated for both tests. Results: A total of 1,122 patients were included for analysis, 866 with intraoperatively confirmed SSC tears (77%) and 256 without (23%). The BH test diagnosed SSC tears with a sensitivity of 46.1% and a specificity of 83.2%, whereas the BP test diagnosed tears with a sensitivity of 23.3% and a specificity of 93.4%. Overall, both tests missed SSC tears in 42.3% (n = 475) of cases. The BH test had accuracy rates of 25.9% for SSC type I tear, 48.7% for type II tear, 65% for type III tear, and 81.7% for type IV-V tear. In contrast, the BP test had accuracy rates of 7.6% for type I tear, 14.7% for type II tear, 42% for type III tear, and 68.7% for type IV-V tear. Conclusions: The BH test had greater sensitivity than the BP test in identifying SSC tears. Both tests showed low accuracy in identifying SSC tears as tear size decreased. Combining both tests did not provide any additional benefits over using the BH test alone. Level of Evidence: Level III, diagnostic study.