Belly Press Test

Original Editor - Lilian Ashraf
Top Contributors - Lilian Ashraf and Kim Jackson

Purpose[edit | edit source]

The belly-press test is used to isolate the subscapularis muscle, to test the subscapularis muscle for tear or dysfunction. It is often used as an alternative to the lift-off test, when the lift-off test can’t be performed because of pain or limited internal rotation range of motion of the shoulder. [1][2]

Technique[edit | edit source]

The patient sits or stands with the elbow flexed to 90 degrees, with the palm of the hand on the upper abdomen, just below the xyphoid process.

The patient is asked to press the palm of the hand against the abdomen, through shoulder internal rotation.

The test is positive for subscapularis muscle dysfunction if the patient compensates the movement through started wrist flexion, shoulder adduction and shoulder extension. This unconscious compensatory movement would result in the elbow dropping behind the trunk. [1][2]

[3]

Evidence[edit | edit source]

The sensitivity of belly-press test in the diagnosis subscapularis muscls tear is 0.34 and specificity is 0.96. If only grade 2-4 tears were analyzed the sensitivity was 0.37 and specificity was 0.92.[4]

The study by Angela Cadogan et al found that the belly-press test demonstrated acceptable level of inter-examiner reliability. The kappa coefficient  was 0.65-0.78 and percent agreement was 83-89%, making it appropriate for in cooperation in physical examination of painful shoulder conditions.[5]

Both the lift-off test and the belly-press test primarily challenge the subscapularis muscle. The subscapularis muscle has two separate innervations and function, while both tests stimulate the upper and lower portions of subscapularis muscle. A study by Tokish JM et al comparing the lift-off test and the belly-press test, concluded that the lift-off test activated the lower subscapularis muscle more and the belly-press test activated the upper subscapularis muscle more.[2]

References[edit | edit source]

  1. 1.0 1.1 Dutton M, Magee D, Hengeveld E, Banks K, Atkinson K, Coutts F, Hassenkamp AM. Orthopaedic examination, evaluation, and intervention. McGraw-Hill Medical; 2004.
  2. 2.0 2.1 2.2 Tokish JM, Decker MJ, Ellis HB, Torry MR, Hawkins RJ. The belly-press test for the physical examination of the subscapularis muscle: electromyographic validation and comparison to the lift-off test. Journal of shoulder and elbow surgery. 2003 Sep 1;12(5):427-30.
  3. The Physio Channel. Belly-press Rotator Cuff Subscapularis Test. Available from: https://www.youtube.com/watch?v=cI4GN8NqRdg [last accessed 9/1/2021]
  4. Kappe T, Sgroi M, Reichel H, Daexle M. Diagnostic performance of clinical tests for subscapularis tendon tears. Knee Surgery, Sports Traumatology, Arthroscopy. 2018 Jan 1;26(1):176-81.
  5. Cadogan A, Laslett M, Hing W, McNair P, Williams M. Interexaminer reliability of orthopaedic special tests used in the assessment of shoulder pain. Manual therapy. 2011 Apr 1;16(2):131-5.