Bear hug test: Procedure, interpretation and free template

The bear hug test is a quick shoulder special test that screens for subscapularis tears, one of the easiest rotator cuff injuries to miss. A patient who cannot hold the hand pressed on the opposite shoulder against the examiner’s resistance may have a subscapularis problem. In the study that introduced it, the bear hug test caught 60% of the tears confirmed at arthroscopy. That beat the belly press, Napoleon and lift-off tests.

Getting it right matters, because a missed tear can leave a patient on the wrong rehab plan. Below, you’ll find the setup, how to grade the result, how it stacks up against the other tests, and a free recording form.

Key takeaways

The bear hug test screens for subscapularis tears through resisted internal rotation, with the palm on the opposite shoulder.

It is positive when the examiner can lift the hand off the shoulder, or the patient is clearly weaker than the other side.

In the original 2006 study it caught 60% of tears, more than the belly press, Napoleon or lift-off tests.

A positive result suggests at least 30% of the tendon is torn, so confirm it with MRI or ultrasound.

Record the side, elbow position, hold time and the other arm’s result so the next clinician can repeat the test.

What the bear hug test tells you

The bear hug test is a resisted special test used to detect subscapularis tears and weakness. The patient presses the hand into the shoulder while the examiner tries to lift it off by pulling the forearm. The elbow is held forward throughout. That position loads the subscapularis in resisted internal rotation.

Barth, Burkhart and De Beer first described the test in 2006 in a paper in Arthroscopy. It has since become a routine part of shoulder assessment in physical therapy and sports medicine.

The subscapularis turns the arm inward

The subscapularis is the largest and most powerful of the four rotator cuff muscles. It runs from the front of the shoulder blade to the lesser tubercle of the humerus. Its main job is internal rotation of the shoulder.

• Primary action: internal rotation of the glenohumeral joint
• Secondary role: stabilizing the front of the humeral head
• Clinical relevance: a tear weakens internal rotation, the movement the bear hug test resists

Reach for it when internal rotation feels weak

Use the bear hug test when a patient has pain at the front of the shoulder or weakness reaching behind the back. Trouble tucking in a shirt is another common clue. It also earns a place whenever you suspect wider rotator cuff involvement.

It works best alongside other shoulder special tests, since no single maneuver covers every lesion. Here is how to run it.

How to perform it in five steps

Set the patient up the same way every visit, so results stay comparable over time.

1. Position the patient standing or sitting, with the affected palm flat on the opposite shoulder, fingers extended and the elbow held forward.
2. Stand beside the patient and grip the forearm just above the wrist.
3. Ask the patient to press the hand firmly into the shoulder. Meanwhile, apply an upward pull on the forearm (external rotation) to lift the hand off the shoulder.
4. Hold for several seconds, watching for the hand lifting away from the shoulder or the elbow drifting back.
5. Repeat on the other side and record any difference in strength or control.

A positive result means the hand comes off the shoulder

Record a positive result when the examiner can lift the hand off the shoulder, or the patient is clearly weaker than the other side. Some researchers set the weakness cut-off at 20% less resistance than the uninjured arm.

A positive test suggests subscapularis insufficiency, but it does not confirm a tear on its own. Confirmation usually requires MRI or ultrasound, read alongside the history and your other shoulder tests.

A worked example

Say a 54-year-old patient fell onto an outstretched arm three weeks ago. Now they struggle to tuck in a shirt on the right side. Their lift-off test is normal, yet you lift the right hand off the shoulder with little effort. The left side holds firm.

That pattern fits a partial tear of the upper subscapularis better than a massive one. Lift-off tests tend to stay negative until about three-quarters of the tendon is torn. Refer for imaging, and note both tests and both sides.

It catches more tears than the other subscapularis tests

In the original study, 68 patients were examined before shoulder arthroscopy, which then served as the reference standard. Subscapularis tears turned up in 29.4% of them.

The bear hug test was the most sensitive, at 60%. The belly press reached 40%, the Napoleon test 25% and the lift-off test 17.6%. All four were highly specific, from 91.7% for the bear hug to 100% for the lift-off.

The tear size each test needs explains that spread, as the chart below shows.

Positive bear hug and belly press tests suggest at least 30% of the tendon is torn. The Napoleon test needs more than half, and the lift-off test at least 75%. Even so, all four tests together missed 40% of the tears in the study.

Later studies report wider ranges. A 2015 Brazilian study found 75% sensitivity but only 56% specificity. When the history still points to a tear, a negative test should not stop a referral.

Bear hug, belly press or lift-off: Which one to use

Each test loads the subscapularis in a different position, so the right choice depends on the patient in front of you.

The lift-off test needs the hand behind the back, which a stiff or painful shoulder often cannot reach. The bear hug avoids that problem, because the hand stays in front of the body.

The belly press test matched the bear hug on overall accuracy in the original study. Running both together gives you a second reading on the same tear size.

Common mistakes that skew the result

• Pain can limit effort and produce a false positive, so ask whether pain or weakness ended the hold.
• Pulling on the elbow instead of the forearm changes the force direction and the result.
• Letting the elbow drift down to the side changes the test position from visit to visit.
• Testing only one side leaves you with no baseline for “clearly weaker”.
• Biceps or other rotator cuff problems can confound findings, so read the result alongside your other tests.

Stay within your scope of practice. Scope and referral pathways differ by state, country and qualification, so check your regulator’s guidance.

Where it fits in a full shoulder exam

Run the bear hug test as part of a sequence, never in isolation. Start with history and range of motion, then add resisted tests. Only then decide whether imaging is needed.

1. Take a history of onset, night pain and any trauma.
2. Assess active and passive range of motion.
3. Perform resisted tests, including the bear hug test.
4. Record findings and decide on onward referral.

Our guide to the shoulder exam walks through the full sequence, including the tests that pair well with this one.

Document the result so the next clinician can repeat it

A bear hug result is only useful if someone else can run the same test the same way. That means writing down the setup, not just the verdict.

Before you finish: A recording checklist

• Side tested, and the result on the other side
• Patient position and elbow height
• Where you applied the pull, and roughly how hard
• Whether the patient held the position for the full hold time
• Any pain during the test, and where it was felt
• Positive, negative or equivocal, plus your referral decision

The free form above gives you a place for the date and your notes. Many teams copy these fields into their physical therapy SOAP notes, so the test sits with the rest of the exam.

In US physical therapy, special tests are part of the evaluation codes (97161 to 97163) and aren’t billed on their own. So the test earns its keep in the note, which is another reason to document it fully.

Who uses the recording form

Physical therapists, physiotherapists and musculoskeletal clinicians use the form when they examine shoulder patients. Sports medicine teams and orthopedic practices use it too, when they need a consistent record of subscapularis testing.

A shared form also reduces variation between clinicians, which makes follow-up results easier to trust. It gives you a clear audit trail if a referral or treatment plan is questioned later.

Keep shoulder test results in one record with Pabau

Paper forms get filed, scanned or lost. Comparing this visit’s bear hug result with last month’s then means hunting through notes. Pabau, the practice management platform we build for allied health teams, keeps those results in one patient record.

Turn the template into one of Pabau’s digital forms, and every clinician captures the same fields each time. Results sit next to the appointment, treatment notes and invoices, so the next clinician sees the history before the patient sits down.

Practices running a full physical therapy EMR also skip re-typing paper findings at the end of the day.

Keep every shoulder test in the patient record

See how Pabau’s digital forms and treatment notes store each special test result with the patient, ready for the next visit.

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Conclusion

Run the bear hug test whenever internal rotation feels weak, and always run it on both sides. It is the most sensitive of the common subscapularis tests, yet it still misses tears.

So treat a positive result as a reason to image, and a negative one as a single data point among several. Write down the setup every time, because a test nobody can repeat can’t track recovery.

Book a demo to see how Pabau keeps every shoulder test result in one patient record, ready for the next visit.

Continue your research

Checking the biceps tendon next? Speed’s test covers technique and interpretation for anterior shoulder pain.

Suspect impingement as well? Neer’s test explains how to perform and read this impingement screen.

Is the scapula part of the problem? Scapular assistance test shows how assisted rotation changes pain and range.

Mapping where the pain sits? Rotator cuff pain location diagram links each pain site to the muscle most likely involved.

Worried about instability? Shoulder relocation test covers technique, interpretation and accuracy.

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