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I'm an athletic trainer working with weight lifters. I heard there's a new test that can be used to look for weakness of the subscapularis tendon in the rotator cuff. With so many older adults coming to us for weight-training, I'm trying to test everyone first before starting a program. What can you tell me about this test?
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You are absolutely right about the need for some prescreening tests before starting weight training with older adults. Anyone age 60 and older should always seek medical counsel first before starting a new exercise program.
The presence of undiagnosed conditions such as aortic aneurysms, rotator cuff tears, and high blood pressure must be identified and treated before establishing or increasing a strenuous exercise program.
Once the client has been medically cleared for weight-training (or other types of exercise), simple tests can be applied to look for shoulder instability. Most of these are well-known to orthopedic surgeons, physical therapists, and athletic trainers.
But recent studies with more sophisticated technology has shown us that some of these tests (e.g., lift off, Napoleon, belly press) aren't as reliable and sensitive as we once thought they were. In fact, for small or partial thickness subscapularis tears, these tests are very inaccurate.
The belly-off sign is very sensitive for all sizes of subscapularis tears. With the arm internally rotated and the hand resting against the belly, the patient tries to lift the hand away from the stomach while the examiner resists the motion. Inability to move the hand off the abdomen is a sign that the subscapularis is not functioning properly. But the test requires the patient to use the external rotator muscles. If these are torn in a massive rotator cuff, the test can't be used.
A new test called the bear-hug test may be the answer. In this test, the patient places the hand of the involved shoulder on his or her opposite shoulder. The fingers are straight and pointing back. The forearm and elbow are lifted up (the point of the elbow is facing forward).
The examiner tries to pull the patient's hand up and off the shoulder. The patient tries to keep the hand on the shoulder. With a normal, strong scapularis, the patient should be able to keep the hand down. With a subscapularis tear, the examiner will be able to easily lift the patient's hand off the shoulder. Compared with other tests for subscapularis tears, the bear-hug is the most accurate. But more studies are needed to confirm the use of this test with partial- and full-thickness tears.
In the meantime, research efforts have been made to look at preoperative imaging as a diagnostic tool. CT scans and MRIs haven't been very successful identifying subscapularis tears.
Arthroscopic exam still remains the most sensitive and reliable test. It is more invasive, especially for those patients who don't have a rotator cuff tear. But it is the first-step in the treatment of rotator cuff tears. So, if there are any signs of a subscapularis tear, then referral to an orthopedic surgeon for an (arthroscopic) exam is advised.
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