Internal Rotation Resistance Test at Abduction and External Rotation: a New Clinical Test for Diagnosing Subscapularis Lesions

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2013 Dec 17

PMID 24337464

Citations 9

Authors

Lin Lin

Hui Yan

Jian Xiao

Yingfang Ao

Guoqing Cui

Affiliations

Soon will be listed here.

Abstract

Purpose: A new clinical test for evaluating subscapularis (SSC) integrity was described, and its diagnostic value was compared with the present SSC tests (the lift-off, belly-press, IRLS and bear-hug tests). The new test is called internal rotation resistance test at abduction and external rotation (IRRT). The test is performed at maximal 90° of abduction and maximal external rotation.

Methods: Two hundred and thirty-five consecutive patients suffering from rotator cuff injury were evaluated preoperatively. Six tests were performed to assess the function of the SSC: the lift-off, belly-press, IRLS, the bear-hug, IRRT at 0° abduction and 0° external rotation (IRRT0°) and IRRT at maximal 90° abduction and maximal external rotation (IRRTM). Arthroscopic findings were the reference for diagnosing of SSC lesions.

Results: The IRRTM test showed the greatest sensitivity (76.5 %), and IRLS (31.6 %) test had the lowest sensitivity. The IRRTM had the highest accuracy (79.0 %), and lift-off had the lowest accuracy (65.3 %). Positive IRRTM, bear-hug, belly-press, IRRT0° tests indicate that about one-third of the SSC is torn, and a positive lift-off and IRLS tests predict a severe tear at least two-thirds of the SSC.

Conclusions: The IRRTM represents a sensitive diagnostic test for SSC lesions and improves the chance of finding the upper part of the SSC tears. When the IRRTM is positive, the surgeon should pay particular attention to detecting the SSC tendon during arthroscopy.

Level Of Evidence: Diagnostic study, Level I.

Citing Articles

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.

Kilic A, Ardebol J, Pak T, Menendez M, Denard P Arthrosc Sports Med Rehabil. 2023; 6(1):100830.

PMID: 38075394 PMC: 10698570. DOI: 10.1016/j.asmr.2023.100830.

The prevalence, classification, radiological and arthroscopic findings of intratendinous subscapularis tears.

Lin L, Zhang L, Cui G, Yan H Knee Surg Sports Traumatol Arthrosc. 2022; 31(5):1970-1977.

PMID: 36454292 DOI: 10.1007/s00167-022-07262-2.

Diagnostic Accuracy of Clinical Tests for Subscapularis Tears: A Systematic Review and Meta-analysis.

Ladermann A, Collin P, Zbinden O, Meynard T, Saffarini M, Chiu J Orthop J Sports Med. 2022; 9(9):23259671211042011.

PMID: 35146034 PMC: 8822023. DOI: 10.1177/23259671211042011.

A Correlation Study of Clinical Outcomes by Quantification of Fatty Degeneration of the Subscapularis: Partial vs. Whole Cross-section.

Park J, Lee K, Rhee S, Oh J Clin Shoulder Elb. 2020; 21(2):67-74.

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Evidence-Based Physical Examination for the Diagnosis of Subscapularis Tears: A Systematic Review.

Dakkak A, Krill M, Krill M, Nwachukwu B, McCormick F Sports Health. 2020; 13(1):78-84.

PMID: 32822265 PMC: 7734364. DOI: 10.1177/1941738120936232.

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