Belly-Off Sign

Introduction[edit | edit source]

When the IRLS or lift off test cannot be performed due to a deficit in range or pain the belly press test could be used to assess the subscapularis muscle.

Lift off test: Arm is internally rotated and extended , with the hand on the lumbar region. From this position the patient is asked to lift the arm off the back posteriorly.

Internal rotation lag sign: With the same starting position as above, the arm is taken into an almost maximal internal rotation. The dorsum of the hand is then fully lifted away from the body till a full internal rotation is achieved. The patient is then asked to actively maintain this position. A deficit between the actively maintained range and the passively placed range indicates the test is positive.

Procedure[edit | edit source]

The subject is asked to press the abdomen with a flat hand as the arm is maintained in maximal internal rotation.

Inference[edit | edit source]

Test is positive if the elbow drops in the posterior direction, indicating a loss of internal rotation, with pressure being exerted only by shoulder extension and wrist flexion. This position is called Napoleans sign.

Properties[edit | edit source]

With intact external rotators, subtle lesion's of the subscapularis tendon and postoperative subscpularis weakness the belly off sign is a promising new clinical tool.

With lack of external rotators, the belly off sign looses its diagnostic value as it becomes negative.[1][2][3]

References[edit | edit source]

  1. Scheibel M, Magosch P, Pritsch M, Lichtenberg S, Habermeyer P. The belly-off sign: a new clinical diagnostic sign for subscapularis lesions. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2005 Oct 1;21(10):1229-35.
  2. Jain NB, Wilcox III RB, Katz JN, Higgins LD. Clinical examination of the rotator cuff. PM&R. 2013 Jan 1;5(1):45-56.
  3. Alqunaee M, Galvin R, Fahey T. Diagnostic accuracy of clinical tests for subacromial impingement syndrome: a systematic review and meta-analysis. Archives of physical medicine and rehabilitation. 2012 Feb 1;93(2):229-36.