Shoulder discomfort affects many individuals, often limiting daily activities and athletic performance. Pinpointing the exact cause of shoulder pain is a primary step in guiding appropriate care. Healthcare professionals employ various physical examination techniques to assess the shoulder joint and identify potential sources of pain. The Neer Impingement Test is a common maneuver used to evaluate specific shoulder conditions.
What is Shoulder Impingement?
Shoulder impingement syndrome, also known as subacromial impingement syndrome, occurs when soft tissues within the shoulder joint become compressed or irritated. This happens as the arm is lifted, causing structures like the rotator cuff tendons and the subacromial bursa to rub against the underside of the acromion, a bony projection of the shoulder blade. This repetitive compression can lead to inflammation and pain.
Common causes include repetitive overhead activities, such as painting, swimming, or throwing sports. Structural factors like bone spurs on the acromion or issues with the rotator cuff tendons can also contribute. Individuals experience symptoms such as pain when raising the arm overhead, reaching behind the back, or lying on the affected shoulder. Weakness in the arm and a reduced range of motion are also reported.
How the Neer Impingement Test is Performed
The Neer Impingement Test is a physical examination maneuver performed by a healthcare professional to assess for shoulder impingement. The patient sits or stands comfortably during the procedure. The examiner positions themselves to manipulate the patient’s arm and stabilize the shoulder blade.
To begin, the examiner places one hand on the patient’s shoulder blade (scapula) to stabilize it. The other hand grasps the patient’s arm (humerus) just above the elbow. The examiner then passively raises the patient’s arm forward and upward, fully flexing it overhead. Throughout this motion, the arm is kept internally rotated, with the thumb pointing downward. This maneuver aims to compress the rotator cuff tendons and the subacromial bursa against the anterior portion of the acromion.
Interpreting the Neer Test Findings
Interpretation of the Neer Impingement Test relies on the patient’s pain response during the maneuver. A positive Neer test is indicated by the reproduction of the patient’s familiar shoulder pain as the arm is passively flexed overhead with internal rotation. This pain suggests compression of the subacromial structures, indicating subacromial impingement.
This test serves as one component of a broader clinical assessment. Healthcare providers perform the Neer test in conjunction with other specific shoulder tests, such as the Hawkins-Kennedy test, to gather additional information. While a positive result can indicate impingement, it is not solely relied upon for a definitive diagnosis. Further diagnostic tools, including X-rays to assess bone structure or MRI scans to visualize soft tissues, are used to confirm the condition and rule out other potential causes of shoulder pain. A negative test suggests the absence of impingement during the maneuver, but it does not entirely exclude the condition, as impingement can vary in severity.