Test library › Shoulder & upper arm
Bear-hug test
For: Subscapularis tear
Website-only test: not part of the book.
A tear in the subscapularis, the rotator cuff tendon at the front of the shoulder that turns the arm inwards (internal rotation).
Best used to rule inLikelihood ratios calculated from the review's pooled sensitivity and specificity.
Caution: Pooled from 4 studies whose sensitivities disagreed widely, so the average hides very inconsistent results.
How it is done
The patient places the palm of the affected arm on the opposite shoulder, fingers straight and the elbow held in front of the body, and tries to keep it there while the examiner tries to lift the hand off the shoulder with an outward-rotation (external rotation) force at right angles to the forearm. Positive: the patient cannot keep the hand on the shoulder, or resists with clear weakness compared with the other side.
What the studies found
Subscapularis tear. Sensitivity 55% (95% CI 28–79%) and specificity 94% (95% CI 80–99%) are the pooled estimates of Lädermann et al. 2021 (systematic review and meta-analysis; 4 studies, 598 patients). The review rated it the most promising of the four subscapularis tests it could pool, but sensitivity was the weakness of all of them, so a negative bear-hug does not rule a tear out. The original study by the test's developers (Barth 2006, 68 consecutive patients before arthroscopy) reported sensitivity 60% and specificity 91.7% (95% CI 39–78% and 80–97%, as tabulated by Lädermann 2021). A positive test may also reflect a biceps problem: Kibler 2009 found the bear-hug the most sensitive test for biceps disease (sensitivity 79%).
What the numbers mean
- Positive result: a moderate rule-in: a positive result makes the diagnosis clearly more likely.
- Negative result: a small shift: a negative result nudges the diagnosis down, but does not exclude it.
The ladder: what a result does to your estimate
| If you thought | After a positive | After a negative |
|---|---|---|
| 10% | 51% | 5% |
| 30% | 80% | 17% |
| 50% | 90% | 32% |
Calculated from the likelihood ratios above. Read the caution above before relying on these. For any other starting estimate, use the probability calculator.
Work out what a result means for your patient: probability calculator
Other tests in the library for subscapularis tear
Compare all the tests for subscapularis tear side by side
Source
Lädermann A, Collin P, Zbinden O, Meynard T, Saffarini M, Chiu JCH. Diagnostic Accuracy of Clinical Tests for Subscapularis Tears: A Systematic Review and Meta-analysis. Orthop J Sports Med. 2021;9(9):23259671211042011. Journal article (DOI) · meta-analysis
Also cited: Barth JR, Burkhart SS, De Beer JF. The bear-hug test: a new and sensitive test for diagnosing a subscapularis tear. Arthroscopy. 2006;22(10):1076–1084. Journal article (DOI)
Also cited: Ben Kibler W, Sciascia AD, Hester P, Dome D, Jacobs C. Clinical utility of traditional and new tests in the diagnosis of biceps tendon injuries and superior labrum anterior and posterior lesions in the shoulder. Am J Sports Med. 2009;37(9):1840–1847. Journal article (DOI)
Website-only test: added to the library on 9 October 2026 and not part of Rule It In, Rule It Out. Figures independently checked against the sources cited above; any note above says where only the abstract could be checked. If a newer or better study changes them, this page will be updated.
Get the book for the shoulder questions that matter: neck or shoulder, a painful cuff or a torn one, and an unstable joint or the labrum
This test is in the website library only; it is not one of the tests in Rule It In, Rule It Out. The book covers the tests in its ‘The shoulder’ chapter: how to do each one, what counts as positive, and how to read the result.
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