The Belly Press Test assesses subscapularis function by testing the client’s ability to maintain internal rotation pressure against the abdomen without compensating. A positive finding may include weakness, inability to keep the elbow forward, wrist flexion compensation or familiar anterior shoulder pain compared with the other side. A 2022 systematic review and meta-analysis found that common subscapularis tests, including the Belly Press Test, generally have high specificity but low sensitivity, so a positive test may increase suspicion but a negative test cannot rule out subscapularis involvement.
A client reports anterior shoulder pain or weakness during pressing, reaching across the body, pushing or internal rotation tasks. They may be able to lift the arm overhead but struggle to generate force when the shoulder is placed into internal rotation.
The Belly Press Test helps assess subscapularis-biased internal rotation performance. The result is most useful when pain, weakness, elbow position, wrist compensation and side-to-side differences are recorded clearly.
Test name: Belly Press Test
Also known as: Napoleon Test in some variations
Body region: Shoulder, rotator cuff, subscapularis
Purpose: Assess subscapularis function and resisted internal rotation
Positive finding: Weakness, inability to maintain pressure, elbow dropping backwards, wrist flexion compensation or familiar pain compared with the other side
Negative finding: Maintains pressure and elbow position without meaningful weakness or familiar symptoms
Best used with: Bear Hug Test, Lift-Off Test, Internal Rotation Lag Sign, shoulder ROM and rotator cuff strength testing
Key limitation: A negative test does not rule out subscapularis tear or dysfunction
The Belly Press Test is a resisted shoulder internal rotation test. The client places the palm of the tested hand against the abdomen and presses inward while maintaining the elbow forward.
If the subscapularis cannot generate or maintain internal rotation force, the client may compensate by extending the shoulder, flexing the wrist or letting the elbow drift backwards.
The test is used when subscapularis involvement is part of the clinical reasoning.
It may help assess anterior shoulder symptoms, internal rotation weakness, rotator cuff involvement and difficulty with pressing, pushing or reaching tasks.
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, anterior shoulder symptoms, biceps-related symptoms, stiffness, effort or broader rotator cuff involvement.
This test may be useful for clients with anterior shoulder pain, internal rotation weakness, suspected rotator cuff involvement, pressing symptoms, lifting symptoms or difficulty reaching across the body.
Use when subscapularis function is relevant and the client can place the hand against the abdomen comfortably.
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.
Chair or standing space
Pain and strength scale
Measurz recording workflow
Optional dynamometer for related strength testing
Optional comparison side notes
Position the client sitting or standing upright.
Ask the client to place the palm of the tested hand flat against the abdomen.
Stand in front of or beside the client.
Observe the elbow, wrist and shoulder. Manual resistance may be applied depending on the selected method.
Keep the trunk still and avoid shoulder shrugging or trunk rotation.
Ask the client to press the palm into the abdomen while keeping the elbow forward. If testing resistance, apply a gentle outward force and ask the client to maintain the position.
Ask the client to press and report pain, weakness, apprehension or familiar symptoms.
A positive finding is weakness, inability to maintain pressure, elbow dropping backwards, wrist flexion compensation or familiar pain compared with the other side.
A negative finding is maintaining pressure and elbow position without meaningful weakness or familiar symptoms.
Stop if pain increases sharply, the client cannot hold the position, guarding occurs or symptoms are not tolerated.
Do not overpower the client. Record whether the finding is pain, weakness, compensation or all three.
A positive Belly Press Test may increase suspicion of subscapularis involvement when weakness or compensation is clear and supported by other internal rotation tests.
A negative test does not rule out subscapularis tear or rotator cuff involvement. Smaller tears, partial tears or pain-inhibited movement may not be detected clearly by this test.
Interpretation is stronger when combined with Bear Hug Test, Lift-Off Test, Internal Rotation Lag Sign, shoulder internal rotation strength, history and imaging where clinically relevant.
The Belly Press Test generally appears to have:
Lower sensitivity
Higher specificity
That means it may miss some subscapularis tears, especially smaller or partial tears, but a positive result can increase suspicion of subscapularis involvement.
Commonly reported values across studies are approximately:
Sensitivity: around 28–40%
Specificity: around 97–98%
So the Belly Press Test is often better for ruling in subscapularis involvement when positive, rather than ruling it out when negative.
A 2023 retrospective study comparing Bear Hug and Belly Press testing reported that the Bear Hug Test improved sensitivity compared with Belly Press for subscapularis tears, reinforcing that Belly Press should not be used in isolation.
Reliability depends on consistent hand position, elbow position, resistance direction, comparison side and whether the finding is recorded as pain, weakness, wrist compensation or elbow-position loss.
Common errors include allowing wrist flexion compensation, failing to monitor elbow position, pulling too hard, not comparing sides, recording pain and weakness as the same finding and treating a negative result as a rule-out.
Limitations include low sensitivity, pain inhibition, compensation, partial tears, effort variation and limited ability to isolate subscapularis perfectly.
Use the Belly Press Test to document internal rotation strength and compensation in a subscapularis-biased position. It is most useful when paired with other subscapularis tests and strength measures.
Record test name, side tested, result, pain score, symptom location, weakness yes/no, ability to maintain hand pressure, elbow position, wrist compensation, resistance level, comparison side, confidence in result and reason for stopping.
Add related findings such as Bear Hug, Lift-Off, Internal Rotation Lag Sign, shoulder ROM, internal rotation strength, rotator cuff strength and functional symptoms.
Bear Hug Test
Lift-Off Test
Internal Rotation Lag Sign
Shoulder Internal Rotation Test
Shoulder Strength Testing
Empty Can Test
Full Can Test
Infraspinatus Test
It assesses resisted shoulder internal rotation in a position that biases the subscapularis.
Weakness, inability to maintain pressure, elbow dropping backwards, wrist flexion compensation or familiar pain compared with the other side.
No. It may increase suspicion, but no single test is enough to diagnose a tear.
No. Subscapularis tests tend to have low sensitivity, so a negative result does not rule out involvement.
Record side, pain, weakness, elbow position, wrist compensation, comparison side and stopping reason.
The Belly Press Test assesses subscapularis-biased internal rotation.
A positive result may increase suspicion of subscapularis involvement.
A negative result does not rule out a tear.
Elbow and wrist compensation must be recorded.
Measurz should capture pain, weakness, compensation and comparison side.
Barth, J. R. H., Burkhart, S. S., & De Beer, J. F. (2006). The bear-hug test: A new and sensitive test for diagnosing a subscapularis tear. Arthroscopy, 22(10), 1076–1084. https://doi.org/10.1016/j.arthro.2006.05.005
Gismervik, S. Ø., Drogset, J. O., Granviken, F., Rø, M., & Leivseth, G. (2017). Physical examination tests of the shoulder: A systematic review and meta-analysis of diagnostic test performance. BMC Musculoskeletal Disorders, 18, 41. https://doi.org/10.1186/s12891-017-1400-0
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. Needs verification.
