Which test requires the patient to place the hand behind the back and resist internal rotation?

• A. Napoleon's Sign
• B. Gerber's Lift-Off Sign
• C. Hawkins/Kennedy
• D. Neer's Test

Answer: (B)

The test in focus specifically assesses the strength and integrity of the subscapularis, the muscle that mainly rotates the arm inward. In this maneuver, you place the back of the hand on the mid-lumbar region behind the back and then try to lift the hand away from the back while the examiner provides resistance to internal rotation. Because the subscapularis powers internal rotation and helps keep the hand pressed against the back, weakness or a tear in this tendon will prevent the hand from maintaining that position against the applied resistance. A positive result—inability to hold the hand behind the back or to lift it off against resistance—points to subscapularis pathology.

The other tests listed target different shoulder problems. Impingement tests like the Hawkins/Kennedy and Neer provoke symptoms by compressing structures under the acromion, rather than assessing subscapularis strength in the behind-the-back position.