Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original articleThe Belly-Off Sign: A New Clinical Diagnostic Sign for Subscapularis Lesions
Section snippets
Methods
Sixty patients (44 male and 16 female) with a mean age of 55.3 years (range, 26 to 83 years) and clinical, surgical, and/or magnetic resonance imaging (MRI)–confirmed evidence of a lesion of the subscapularis musculotendinous unit were included in this descriptive and explorative study.
In all patients, a complete physical examination of both shoulders, standard radiographic examination, and MRI were performed. On physical examination, special attention was paid to the integrity of the rotator
Group I: Isolated Partial Subscapularis Tendon Tears
Nine patients had an arthroscopically confirmed isolated partial tear of the upper subscapularis tendon. In all patients, the lift-off test, the IRLS, the Napoleon sign, and the belly-off sign could be evaluated. The lift-off test was found to be positive in 2 patients (22%). The IRLS was graded as intermediate in 3 patients (33%) and in the remaining patients it was negative. The Napoleon sign was graded as intermediate in 5 (56%) patients and negative in 4. All patients in this group had a
Discussion
Different clinical tests and diagnostic signs have been described in the literature to evaluate the function and integrity of the subscapularis musculotendinous unit. The lift-off test has been reported to be very reliable in patients with complete subscapularis tears who were able to perform the test.1, 3 Our study confirmed previous observations that the lift-off test is of limited value in patients who cannot bring the affected arm into the starting position required because of pain and/or
Conclusions
This report represents a descriptive and explorative study of a new diagnostic sign, the belly-off sign, and describes its relative diagnostic value in comparison with the lift-off test, IRLS, and belly-press/Napoleon sign in cases of different types of subscapularis lesions. A valid statistical estimation of specificity, sensitivity, and positive or negative predictive values was not possible in this study because the different diagnostic tests and signs were only evaluated in patients with
Acknowledgment
The authors thank Rüdiger Himmelhan for the illustrations.
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