Belly Press Test: Subscapularis Examination Technique, Positive Result and Accuracy

Published October 20, 2026 Read time 5 min read Readers 64
Belly Press Test

The belly press test, also called the abdominal compression test, is a bedside shoulder test for assessing the subscapularis. It is quick, needs no equipment, and suits patients who cannot place the hand behind the back for the lift-off test because of pain or stiffness.

What Is the Belly Press Test Used For?

The test screens for subscapularis muscle and tendon pathology. The subscapularis is the largest and strongest rotator cuff muscle, and it is the main internal rotator of the shoulder. Its tears are often missed in routine practice [1,2]. An electromyographic study in healthy volunteers confirmed that the belly press activates the subscapularis more than the other shoulder muscles tested. It loads the upper subscapularis more than the lift-off test does, so the two tests are not interchangeable [3].

How to Perform the Belly Press Test

  1. Ask the patient to stand or sit with the affected arm at the side and the elbow flexed.
  2. The patient places the flat of the hand on the abdomen and presses inward.
  3. The patient tries to hold the arm in maximal internal rotation, keeping the elbow in front of the trunk.
  4. The examiner watches elbow position, wrist posture and the patient’s ability to maintain pressure.

Interpreting the Result

Normal (Negative) Test

When active internal rotation is strong, the patient holds the hand against the abdomen and the elbow stays in front of the trunk.

Positive Test

When subscapularis strength is impaired, the patient cannot maintain maximal internal rotation and feels weakness. The elbow drops back behind the trunk. With a torn subscapularis tendon, patients often flex the wrist to press against the abdomen and cannot keep the elbow forward. Other studies describe the test as positive when the palm lifts easily off the abdomen [1,4]. Wrist flexion and elbow drop are both compensations for a weak subscapularis.

Accuracy of the Belly Press Test

In the study that compared it with the bear-hug, lift-off and Napoleon tests, the belly press had a sensitivity of 40% and a specificity of 97.9% [5]. That pattern has a clear clinical meaning:

  • High specificity: a positive test strongly suggests a subscapularis tear, so it is useful for ruling the diagnosis in.
  • Low sensitivity: a negative test does not exclude a tear, so it is poor for ruling the diagnosis out.

In the same study, a positive belly press or bear-hug test suggested a tear of at least 30% of the subscapularis [5].

Later studies found lower sensitivity. A study of 312 patients reported 27.8% for any tear, rising to 56.8% for separating full-thickness from partial tears [6]. A large arthroscopy-based series of 866 torn tendons reported 23.3% sensitivity and 93.4% specificity, and concluded that both the belly press and bear-hug tests miss most partial tears [4]. A systematic review found that combining the bear-hug and belly press tests gave the best overall diagnostic performance [7]. Another study found it advisable to perform more than one subscapularis test to improve sensitivity [8].

Clinical Tips

  • Compare with the opposite shoulder, since normal strength and range of motion vary between patients.
  • Do not rely on the belly press alone. Pair it with the bear-hug test, lift-off test or internal rotation lag sign.
  • Confirm uncertain or negative findings with imaging (MRI or ultrasound) when symptoms persist.
  • Watch for pectoralis major and wrist substitution, which can mask weakness.

Research Limitations

Reported accuracy depends on tear size, tear location, patient selection and the reference standard. Most studies were done in surgical populations, so the figures may not carry over to primary care. The elbow-drop sign has no standardized threshold, and examiner experience affects reliability [4,6].

Frequently Asked Questions (FAQ)

What is the belly press test used for?
It assesses the integrity and strength of the subscapularis muscle and tendon.

Is the belly press test the same as the abdominal compression test?
Yes. Both names describe pressing the palm into the abdomen to test internal rotation strength.

What is a positive belly press test?
The patient cannot hold maximal internal rotation, feels weakness, and the elbow drops behind the trunk. Wrist flexion to press on the abdomen is another sign of a torn subscapularis tendon.

How accurate is the belly press test?
In the original comparison study it had a sensitivity of 40% and a specificity of 97.9% [5]. Later studies reported lower sensitivity, so a negative result should not rule out a tear [4,6].

Can a negative belly press test rule out a subscapularis tear?
No. Because of the low sensitivity, a tear can still be present, especially a partial one. Use additional tests or imaging.

Which tests should be combined with the belly press test?
The bear-hug test is the most commonly recommended partner. The lift-off test and internal rotation lag sign are also used [7,8].

When should a patient see an orthopedic specialist?
Persistent shoulder weakness, difficulty with internal rotation, or pain with a positive test should prompt specialist assessment and imaging.

References

  1. Yoon JP, et al. Diagnostic value of four clinical tests for the evaluation of subscapularis integrity. J Shoulder Elbow Surg. 2013;22(9):1186-92. PubMed: https://pubmed.ncbi.nlm.nih.gov/23434234/
  2. Evidence-based physical examination for the diagnosis of subscapularis tears: a systematic review. PubMed ID 32822265. https://vivo.weill.cornell.edu/display/pubid32822265
  3. Tokish JM, et al. The belly-press test for the physical examination of the subscapularis muscle: electromyographic validation and comparison to the lift-off test. J Shoulder Elbow Surg. 2003. https://orthobullets.com/evidence/14564261
  4. The bear hug test improves sensitivity compared with the belly press test for identifying subscapularis tendon tears, but both tests miss the majority of partial tears. Arthrosc Sports Med Rehabil. 2023;6(1):100830. PMC: https://pmc.ncbi.nlm.nih.gov/articles/PMC10698570/
  5. Barth JR, Burkhart SS, De Beer JF. The bear-hug test: a new and sensitive test for diagnosing a subscapularis tear. Arthroscopy. 2006;22(10):1076-84. PubMed: https://pubmed.ncbi.nlm.nih.gov/17027405/
  6. Yoon JP, et al. (2013), as in reference 1.
  7. Systematic review (reference 2): bear-hug plus belly press combination.
  8. Diagnostic performance of clinical tests for subscapularis tendon tears. Knee Surg Sports Traumatol Arthrosc. 2018;26(1):176-81. PubMed: https://pubmed.ncbi.nlm.nih.gov/28676889/