Shoulder Orthopaedic Test: Bear Hug Test

The Bear Hug Test assesses subscapularis function by testing resisted shoulder internal rotation with the hand placed on the opposite shoulder. A positive finding may include weakness, inability to maintain hand position or familiar pain compared with the other side. A 2022 systematic review and meta-analysis found that subscapularis clinical tests, including the Bear Hug Test, generally have high specificity but low sensitivity, meaning a positive test may be more useful than a negative test, but no single test is sufficient to diagnose a subscapularis tear.  

Introduction

A client reports anterior shoulder pain or weakness during pressing, reaching across the body or internal rotation tasks. They may struggle with resisted internal rotation but have relatively preserved elevation.

The Bear Hug Test can help assess subscapularis performance. It should be interpreted with other subscapularis tests, shoulder ROM, strength testing, history and imaging where clinically relevant.

Quick Summary

Test name: Bear Hug Test
Body region: Shoulder, rotator cuff, subscapularis
Purpose: Assess subscapularis function and resisted internal rotation
Positive finding: Weakness, inability to maintain hand position, lift-off of the hand or familiar pain compared with the other side
Negative finding: Able to maintain position against resistance without meaningful weakness or familiar symptoms
Best used with: Belly Press Test, Lift-Off Test, Internal Rotation Lag Sign, shoulder ROM, rotator cuff strength testing and imaging where indicated
Key limitation: A negative test does not rule out subscapularis tear

What Is the Bear Hug Test?

The Bear Hug Test is a shoulder internal rotation resistance test. The client places the hand of the tested arm on the opposite shoulder, with the elbow positioned forward. The professional attempts to lift the client’s hand away while the client resists.

The test challenges the subscapularis muscle and related anterior shoulder structures.

Why It Is Used

The test is used when subscapularis involvement is part of the clinical reasoning.

It may help assess anterior shoulder weakness, internal rotation strength deficit, rotator cuff involvement or difficulty with pressing and reaching tasks.

What It Assesses

The test assesses resisted shoulder internal rotation in a specific position. It does not isolate the subscapularis perfectly and does not confirm a tear on its own.

Weakness or pain may also be influenced by pain inhibition, biceps/anterior shoulder symptoms, effort, stiffness or other rotator cuff involvement.

Who It Is Useful For

This test may be useful for clients with anterior shoulder pain, internal rotation weakness, suspected rotator cuff involvement, pressing symptoms, lifting symptoms or difficulty placing the hand across the body.

When to Use This Test

Use when subscapularis function is relevant and the client can place the hand on the opposite shoulder comfortably.

When Not to Use or When to Be Cautious

Use caution with acute shoulder trauma, severe pain, recent surgery, suspected fracture, high irritability, inability to reach the test position or symptoms that worsen rapidly with resisted movement.

Equipment Required

Chair or standing space
Pain and strength scale
Measurz recording workflow
Optional dynamometer for related strength testing
Optional comparison side notes

Step-by-Step Protocol / Practice

Setup

Position the client sitting or standing upright.

Client position

Ask the client to place the palm of the tested arm on the opposite shoulder, as if giving themselves a hug.

Examiner position

Stand in front of or beside the client.

Hand placement

Place one hand over the client’s wrist or distal forearm.

Stabilisation

Keep the trunk still and avoid shoulder shrugging or elbow dropping.

Movement or force direction

Ask the client to keep the hand on the shoulder while the professional attempts to lift the hand away.

Instructions

Ask the client to resist and report pain, weakness, apprehension or familiar symptoms.

Positive finding

A positive test is weakness, inability to maintain hand position, hand lift-off or familiar pain compared with the other side.

Negative finding

A negative test is the ability to maintain the position against resistance without meaningful weakness or familiar symptoms.

Stopping criteria

Stop if pain increases sharply, the client cannot hold the position, guarding occurs or symptoms are not tolerated.

Safety notes

Do not overpower the client. Compare sides and record whether the finding is pain, weakness or both.

Positive and Negative Test Interpretation

A positive Bear Hug Test may increase suspicion of subscapularis involvement, particularly when weakness is clear and supported by other internal rotation tests.

A negative test does not rule out subscapularis tear or rotator cuff involvement. The test may miss some tears, especially smaller or partial lesions.

Interpretation is stronger when combined with Belly Press, Lift-Off, Internal Rotation Lag Sign, shoulder ROM, internal rotation strength testing, history and imaging where relevant.

Sensitivity, Specificity and Diagnostic Accuracy

A 2022 systematic review and meta-analysis reported that among subscapularis clinical tests, the Bear Hug Test had the highest pooled sensitivity at 0.55, while all analysed tests had pooled specificity above 0.90. The authors concluded that no single clinical test is sufficiently reliable to diagnose subscapularis tears.  

This means a clearly positive Bear Hug Test may increase suspicion, but a negative result cannot confidently rule out subscapularis involvement.

Reliability and Validity

A 2023 study comparing Bear Hug and Belly Press testing reported that Bear Hug may improve sensitivity compared with Belly Press for subscapularis tears, but clinical interpretation still requires comparison with other findings.  

Reliability depends on consistent hand position, elbow position, resistance direction, comparison side and whether the outcome is recorded as pain, weakness or inability to hold.

Common Errors and Limitations

Common errors include poor hand placement, pulling too hard, not comparing sides, recording pain and weakness as the same finding, ignoring elbow position and interpreting a negative test as ruling out a tear.

Limitations include low sensitivity, pain inhibition, compensation, partial tears, client effort and inability to isolate subscapularis perfectly.

Practical Applications

Use the Bear Hug Test to document internal rotation strength and symptom response in a subscapularis-biased position. It is most useful when paired with other subscapularis tests and strength measures.

How to Record This in Measurz

Record test name, side tested, result, pain score, symptom location, weakness yes/no, ability to maintain hand position, resistance level, elbow position, comparison side, compensation, confidence in result and reason for stopping.

Add related findings such as Belly Press, Lift-Off, Internal Rotation Lag Sign, shoulder ROM, internal rotation strength, rotator cuff strength and functional symptoms.

Related Tests / Internal Links

Belly Press Test
Lift-Off Test
Internal Rotation Lag Sign
Shoulder Internal Rotation Test
Shoulder Strength Testing
Empty Can Test
Full Can Test
Infraspinatus Test

FAQs

What does the Bear Hug Test assess?

It assesses resisted shoulder internal rotation in a position that biases the subscapularis.

What is a positive Bear Hug Test?

Weakness, inability to keep the hand on the opposite shoulder or familiar pain compared with the other side.

Can it diagnose a subscapularis tear?

No. It may increase suspicion, but no single test is enough to diagnose a tear.

Can a negative Bear Hug Test rule out a tear?

No. The test has limited sensitivity, so a negative result does not rule out subscapularis involvement.

What should be recorded?

Record side, pain, weakness, hand position, elbow position, comparison side and compensation.

Key Takeaways

The Bear Hug Test assesses subscapularis-biased internal rotation.
A positive test may increase suspicion of subscapularis involvement.
A negative test does not rule out a tear.
Use it with other subscapularis and rotator cuff tests.
Measurz should capture pain, weakness, position and comparison side.

References

Lädermann, A., Denard, P. J., Collin, P., et al. (2022). Diagnostic accuracy of clinical tests for subscapularis tears: A systematic review and meta-analysis. Orthopaedic Journal of Sports Medicine, 10(2), 23259671211042011.

Looze, C. A., et al. (2023). The Bear Hug Test improves sensitivity compared with the Belly Press Test in diagnosing subscapularis tears. Arthroscopy, Sports Medicine, and Rehabilitation.