Which rotator cuff test is used to assess the subscapularis by having the patient lift the hand off the back?

• A. Napoléon's sign
• B. Gerber's lift-off sign
• C. Empty can test
• D. Dropping sign

Answer: (B)

The key idea is that the subscapularis is the primary internal rotator of the shoulder, and its strength is best challenged by having the hand placed behind the back. In the lift-off maneuver, the patient presses the dorsum of the hand against the mid to lower back and is asked to lift the hand away from the back against resistance. A normal subscapularis will allow this lift-off with smooth motion and without weakness. If the patient cannot lift the hand off or achieves only a weak, incomplete lift, this suggests subscapularis tendon pathology or weakness, such as a tear or tendinopathy, since the subscapularis is directly responsible for this motion.

This test is specific to the subscapularis, whereas other options assess different muscles: the empty can test targets the supraspinatus, and signs like the dropping sign relate to inability to maintain arm abduction, not the internal rotation performed in this lift-off maneuver. Napoléon’s sign is another subscapularis-related test but the lift-off variation is the classic method to assess subscapularis integrity by demanding active internal rotation with the hand off the back.