Diagnostic Value of the Supine Napoleon Test for Subscapularis Tendon Lesions

Arthroscopy. 2016 Dec;32(12):2459-2465. doi: 10.1016/j.arthro.2016.04.034. Epub 2016 Jun 24.


Purpose: The purpose of this study was to compare the diagnostic value of the supine Napoleon test (a variation of the belly-press test that reduces compensatory motion) with other clinical tests for subscapularis tendon (SSC) tears.

Methods: One hundred thirty consecutive patients who were scheduled for arthroscopic rotator cuff repair were evaluated preoperatively with the lift-off test, Napoleon test, bear-hug test, and supine Napoleon test. The supine Napoleon test was performed by placing the patient's hand on their belly while they lay supine with an examiner holding their hand and shoulder to prevent compensatory motion. The patient was asked to move their elbow upward and the test was considered positive if they were unable to do so. During surgery, SSC lesions were classified with the Lafosse classification system. Sensitivity, specificity, accuracy, and positive and negative likelihood ratios (LR+, LR-) were calculated for each test. The ability to detect partial SSC tears was compared among the clinical tests.

Results: Fifty-two of 130 patients (40%) had SSC tears confirmed arthroscopically. For diagnosis of these tears, the supine Napoleon test was the most sensitive (84%), followed by the bear-hug test (74%), and the bear-hug test was the most specific (97%), followed by the supine Napoleon test (96%). The LR+ was greatest for the bear-hug test (28.4) and next greatest for the supine Napoleon test (21.9). The LR- was lowest for the supine Napoleon test (0.16) and the bear-hug test was second (0.27). The sensitivity of the supine Napoleon test (65%) was highest for detecting partial tears.

Conclusions: In comparison with other clinical tests for SSC tears, the supine Napoleon test had the greatest diagnostic value for full-thickness SSC tears and was most able to detect partial tears.

Level of evidence: Level III, diagnostic nonrandomized study.

Publication types

  • Comparative Study
  • Video-Audio Media

MeSH terms

  • Adult
  • Aged
  • Arthroscopy
  • Female
  • Humans
  • Male
  • Middle Aged
  • Physical Examination / methods*
  • Rotator Cuff Injuries / diagnosis*
  • Rotator Cuff Injuries / surgery
  • Sensitivity and Specificity
  • Supine Position*