Shoulder examination: Lift-off test for subscapularis tear

The Lift-off Test is a clinical examination commonly used to assess the integrity of the subscapularis muscle, one of the four rotator cuff muscles in the shoulder. This test specifically helps to identify a tear or weakness in the subscapularis. Here is how the test is typically conducted: Patient Positioning: The patient stands or sits. The test is performed on the arm that is suspected of having a subscapularis tear. Test Procedure: The patient is asked to place the dorsum (back) of their hand against the small of their back, with the elbow pointing outwards (external rotation). The hand should be at the level of the mid-lumbar spine, and the palm should face away from the back. The patient is then asked to lift their hand away from their back (into internal rotation). Interpreting the Results: Positive Test: If the patient is unable to lift their hand off their back or can only do so with significant difficulty, this suggests weakness or a tear in the subscapularis muscle. Negative Test: If the patient can lift their hand off their back without difficulty, the subscapularis muscle is likely intact and functioning normally. Indications: This test is particularly useful in diagnosing tears of the subscapularis tendon, which are less common than tears in other parts of the rotator cuff. Caution: Care should be taken when performing this test, especially if the patient is already experiencing shoulder pain, to avoid exacerbating any existing injury. Limitations: The Lift-off Test may be limited in patients who have global weakness, limited shoulder motion due to other reasons, or in cases where pain inhibits their ability to perform the test.