Clinical tests for subscapularis integrity: A “hole” in one?

Thorough physical examination is especially important in the diagnosis of subscapularis tears; given that many tears are missed on MRI evaluation. The belly-press test may be the best test in cases where internal rotation is limited, while the belly-off sign is very sensitive for partial subscapularis tears as long as the external rotators are intact. The internal rotation lag sign, followed by the lift-off test, is the most sensitive test for predicting complete deficiency of the subscapularis when range of motion is not limited.