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Over half of patients older than 60 have a partial or complete tear of one or more rotator cuff muscles. (1) Many of these tears occur in the supraspinatus, but not always! 

This week’s blog and video break down a series of tests to help identify a frequently overlooked cause shoulder pain—the SUBSCAPULARIS.

The subscapularis is hard to say, it’s hard to find, and until now, even harder to assess.  

 The subscapularis is a frequently overlooked generator of shoulder symptoms. Even the gold standard, MRI, demonstrates a paltry sensitivity of 51.6% and specificity of 77.2% for partial-thickness tears. (2) Imaging is not perfect, and orthopedic testing is equally inconsistent. Possibly because the most common test, The Lift-Off Test, is not typically positive until at least 75% of the subscapularis tendon is ruptured. (3)

Fortunately, a new systematic review provided some clarification for assessing the subscapularis:

“The combined application of the bear hug and belly press physical examination maneuvers is an optimal combination for evaluating subscapularis pathology. Positive findings using this test combination in series with a likely pretest probability yield a 96% posttest probability; whereas, negative findings tested in parallel with an unlikely pretest probability yield a 12% posttest probability.” (4)

Time to put this into action! ChiroUp subscribers can review these and hundreds of other tests in your Clinical Evaluations Library.

So, the next time your patient comes in, have confidence in knowing that the most up-to-date recommendations for evaluation & treatment of shoulder pain are at your fingertips.

If you don’t yet have access to ChiroUp, set up an account today by visiting our plans & pricing page. We’d love to have you in our community of more than 1,000 providers throughout the world.

References
  1. Clement ND, Nie YX, McBirnie JM. Management of degenerative rotator cuff tears: a review and treatment strategy. Sports Med Arthrosc Rehabil Ther Technol. 2012;4:48. Link
  2. Brockmeyer M, Schmitt C, Haupert A, Kohn D, Lorbach O. Limited diagnostic accuracy of magnetic resonance imaging and clinical tests for detecting partial thickness tears of the rotator cuff. Arch Orthop Trauma Surg. 2017;137:1719- 1724. Link
  3. Barth JRH, Burkhart SS, De Beer JF. The bear-hug test: a new and sensitive test for diagnosing a subscapularis tear. Arthroscopy. 2006;22:1076-1084. Link
  4. Dakkak, A., Krill, M. K., Krill, M. L., Nwachukwu, B., & McCormick, F. (2020). Evidence-Based Physical Examination for the Diagnosis of Subscapularis Tears: A Systematic Review. Sports Health: A Multidisciplinary Approach, 194173812093623. Link

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