Belly-Off Sign

Original Editor - Ashmitha Patrao

Top Contributors - Ashmita Patrao, Chelsea Mclene and Kim Jackson

Introduction

When the Internal Rotation Lag Sign (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

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

Inference

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

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.