I saw an orthopedic surgeon about six months ago for a shoulder problem. None of the tests done were positive. I went home with an antiinflammatory and exercise program. The problem never got any better. Finally I had an arthroscopic exam, which showed a torn subscapularis muscle. Why couldn't they find this out six months ago?

Clinical tests to detect tears of the subscapularis muscle are less accurate than tests for the other tendons of the rotator cuff. This is most likely because of where the subscapularis muscle is attached and how it functions.

Two clinical tests are commonly used: the lift-off test and the belly-press. Two other tests are also available: the Napoleon test and a new test called the bear-hug test.

When used all together the tests are able to predict the size and place of a tear about 60 per cent of the time. The other 40 per cent can only be seen on arthroscopic exam.

With small tears, a program of conservative care such as you were given is the first choice in treatment. An earlier diagnosis may not have changed the course of care you received. If the patient reinjures the arm (making a larger tear) or has a large tear to begin with, then surgery is more likely.