hey everyone welcome back to clinical physio with me Carlin maydan in today's video we're going to be taking you through the lift off test which is also known as Gerber's test and the purpose of this test is to test the strength and/or the integrity of the subscapularis muscle and its tendon just a quick note before we show you the test we're only going to be completing the test on one of our patient's arms we're not going to look at both in this video as we don't to slow your video down however in practice you always need to compare the right and the left so we're going to ask our patient to turn around so we can go through the test and we're going to be using her left arm for the purpose of the test now the hand can be placed in a couple of positions for this test you can either ask the patient to put their hand on their upper buttock ie where their pocket would be their back pocket or you can ask them to place it in the area of their lumbar lordosis and it's recognized with this test that the subscapularis muscle is put under the greatest stress in this position where the patient's hand on their lower back so what does the examiner do well we can have one hand around the shoulder to stabilize make sure the patient isn't bringing their trunk too far forwards and then the other hand is going to be placed against the patient's palm we're going to use the flat of our hand we're not going to grip the arm or anything like that we're just going to place it there now the first thing to do is to see if the patient can actually produce the liftoff movement so we're going to ask them to see if they can lift their hand away from their back so there we go and we can see that our patient can do that if they were unable to lift their hand off the back this would be a positive result for a subscapularis Ted and we'll talk about that again in a second as we've seen our patient can do this so we can therefore take the test further by then putting our hand against their palm as we said and asking them to continue the same movement pushing their hand away from their back and relax thank you so as we said there's a positive result for a subscapularis tear would be whereby the patient is unable to lift hand off their back one thing to just double-check though before you make that diagnosis is whether they can actually whether they whether their posterior capsule is fluid enough to allow for that movement because sometimes place you can say hard I just can't lift that off and that's because their capsules really really tight so if you've done your movement test and you can see that they can adequately lift a hand off their back but they can't do the liftoff test then that shows you that they have a subscapularis tear if they were able to do it and then we have had the second aspect of the test where they push against our resistance and it was shown to be weak then that may give you a positive for either a subscapularis tendon appa the-- or a general weakness of the subscapularis muscle one more thing to remember which could be a positive is looking at the scapula now as the examiner whilst they're doing the movement we can look at the scapula to see what the scapula is doing any AB any movement that we consider to be abnormal of the scapula for example a form of winging for example may tell us about reduce scapula control so that's the test now what do we find in practice well this is a pretty good test at looking at the subscapularis it's pretty reliable in telling you whether or not this muscle is torn for example however if your patient is unable to get their hand behind the back which a lot of the time can happen because it's a pretty sore movement it's pretty difficult movement if they've got a really irritable shoulder so if you find that they can't actually get their hand behind the back anyway either actively or passively in order to do the test then check out our other video in our special text section which is the belly press test which can also look at the subscapularis muscle