The Neer Impingement Test is a common physical examination maneuver used by healthcare professionals during a shoulder evaluation. Named after Dr. Charles Neer, who described the concept of shoulder impingement in the 1970s, the test identifies potential sources of pain, often presenting as discomfort during overhead activities. It is one of several assessments a clinician performs to gather information about the patient’s symptoms and functional limitations.
The Specific Condition It Screens For
The Neer test primarily screens for Subacromial Impingement Syndrome, often called shoulder impingement. This disorder occurs when soft tissues in the subacromial space—the narrow area beneath the acromion (the bony tip of the shoulder blade)—become compressed or irritated. The structures most commonly affected are the rotator cuff tendons, such as the supraspinatus, and the subacromial bursa, a fluid-filled sac.
Impingement occurs when these structures are pinched against the undersurface of the acromion or the coracoacromial ligament during arm movements. Repetitive overhead motion, such as in swimming or throwing sports, frequently causes this by repeatedly narrowing the subacromial space. This mechanical irritation can lead to inflammation of the bursa (bursitis) or the tendons (tendinopathy). Structural factors, including the shape of the acromion or bone spurs, can also contribute. The test is designed to reproduce the pain associated with this compression.
How the Neer Test is Performed
The Neer test is a passive maneuver, meaning the clinician moves the patient’s arm without the patient’s muscular effort. The patient is typically seated or standing with the arm relaxed at their side. The examiner stabilizes the scapula by placing one hand on the patient’s shoulder blade, preventing upward rotation during the movement.
Using the other hand, the examiner grasps the patient’s arm and positions it in internal rotation, often achieved by turning the arm so the thumb points downward. This rotation is intended to bring the greater tuberosity of the humerus closer to the acromion. The clinician then slowly moves the arm into full forward flexion, lifting it overhead. This passive elevation forces the structures underneath the acromion, recreating the impingement mechanism.
Interpreting the Test Results
The test is considered positive if the patient’s familiar shoulder pain is reproduced during the maneuver. This pain typically occurs as the arm is lifted toward the end range of motion, often between 150 and 180 degrees of flexion, which is the point of maximal subacromial compression. A positive result suggests mechanical irritation within the subacromial space, indicating a potential impingement issue involving the supraspinatus tendon or subacromial bursa.
A positive Neer test alone is not sufficient to make a definitive diagnosis of impingement syndrome. The test is highly sensitive, meaning a negative result helps rule out the problem, but it lacks specificity because pain can be caused by several other shoulder conditions. For example, limited shoulder flexibility or stiffness in the joint capsule may cause discomfort, leading to a false positive result. Therefore, healthcare providers rely on a comprehensive evaluation, combining the Neer test with other specialized maneuvers and imaging studies to confirm the source of pain.