Review Question - QID 3025

The concept tested in this question is whether you know what physical exam finding is associated with a subscapularis tear.

The key physical exam findings are positive Belly-press and Lift-off maneuvers, as well as weakness in internal rotation and increased passive external rotation. The MRI confirms the diagnosis with discontinuity of the subscapularis and the long-head of the biceps not located in the bicipital groove.

Sanders and Miller present a Level 5 review article detailing the correlation between MR images and clinic examinations for shoulder pathology. Part 2 of their 2-part series is also a valuable resource and discusses pathology of the knee.

Tennent et al. present a Level 5 review article discussing the key physical examination pearl for testing the rotator cuff. Part 2 of 2-part series discusses instability and SLAP lesion tests.

Figure A depicts an abnormal belly-press examination whereby the wrist flexes, and the elbow will fall posteriorly as the patient recruits the posterior deltoid to compensate for lack of the subscapularis. Illustration A demonstrates a normal belly-press examination. Illustration B demonstrates a subscapularis tear and associated long head of the biceps dislocation.