An Electromyographic Assessment of the “Bear Hug”: An Examination for the Evaluation of the Subscapularis Muscle Simon Chao, M.D., Stephen Thomas, M.Ed., A.T.C., David Yucha, M.D., John D. Kelly IV, M.D., Jeff Driban, M.Ed., A.T.C., and Kathleen Swanik, Ph.D., A.T.C. Purpose: The lift-off and belly-press tests are common tests for evaluation of the subscapularis. We compared these tests with the recently developed bear-hug test by assessing electromyographic (EMG) activity of the shoulder internal rotators during examination. Methods: Twenty-one healthy male volunteers (mean age, 22.95  3.71 years; mean weight, 73.48  6.93 kg; mean height, 68.76  2.26 cm) with no previous history of shoulder surgery or injury participated in the study. Fine-wire and surface EMG activity of the glenohumeral joint internal rotators (i.e., upper and lower subscapularis, pectoralis major, and latissimus dorsi) was recorded while 5 subscapularis tests were being performed (bear hug at 0°, 45°, and 90°; lift off; and belly press). Peak EMG values were normalized to the maximum voluntary isometric contraction (MVIC) for each muscle. A 4 (muscle)  5 (test) analysis of variance with repeated measures on test was used to analyze peak EMG activity (percentage of maximum voluntary isometric contraction). Follow-up univariate analysis of variance and Tukey post hoc analyses were performed for each of the 5 tests. Results: The bear-hug test performed at 45° of shoulder flexion showed significantly greater peak EMG activity in the upper subscapularis (107.64%  63.52%) and lower subscapularis (85.75%  64.69%) compared with the pectoralis major (41.43%  25.42%) and latissimus dorsi (20.32%  15.70%) (P  .05). The bear-hug test performed at 90° of shoulder flexion showed significantly greater peak EMG activity in the lower subscapularis (166.0%  132.71%) compared with the upper subscapularis (97.23%  70.78%), pectoralis major (50.63%  29.60%), and latissimus dorsi (17.56%  13.64%) (P  .05). The belly-press test showed significantly greater peak EMG activity in the upper subscapularis (77.88%  53.23%) and lower subscapularis (71.82%  46.49%) compared with the pectoralis major (18.49%  14.85%) and latissimus dorsi (34.85%  27.73%) (P  .05). Conclusions: The bear-hug examination performed at 45° of shoulder flexion and the belly-press test may be valuable diagnostic tools in the clinical evaluation of the upper subscapularis muscle. In addition, the bear-hug test at 90° of shoulder flexion may be a valuable diagnostic tool in assessing the clinical function of the lower subscapularis. Clinical Relevance: The bear-hug examination performed at specific degrees of shoulder flexion may be a valuable way to assess the function of the subscapularis muscle. Key Words: Rotator cuff—Shoulder examination—Subscapularis. F ew clinical tests are currently used to evaluate the integrity of the musculotendinous unit of the sub- scapularis muscle. Gerber et al. 1,2 described the lift-off test and belly-press test as reliable maneuvers to detect subscapularis injury. The lift-off test is performed by placing the dorsum of the patient’s hand on his or her From the Department of Orthopaedic Surgery, Temple University Hospital (S.C., D.Y., J.D.K.), and Biokinetics Re- search Laboratory, Temple University (J.D.), Philadelphia, Pennsylvania; Department of Health, Nutrition, and Exercise Science, Human Performance Laboratory, University of Dela- ware (S.T.), Newark, Delaware; and Department of Nursing and Health Sciences, Neumann College (K.S.), Aston, Pennsylvania, U.S.A. The authors report no conflict of interest. Address correspondence and reprint requests to Simon Chao, M.D., Department of Orthopaedic Surgery, 6th Floor, Outpatient Building, Temple University Hospital, Philadelphia, PA 19140, U.S.A. E-mail: schao@temple.edu © 2008 by the Arthroscopy Association of North America 0749-8063/08/2411-7165$34.00/0 doi:10.1016/j.arthro.2008.01.022 1265 Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 24, No 11 (November), 2008: pp 1265-1270