The Neer Impingement Test is a clinical maneuver used by healthcare professionals to evaluate shoulder pain. It is designed to reproduce a patient’s symptoms to determine if discomfort is caused by mechanical compression within the shoulder joint. The test assists in diagnosing subacromial impingement syndrome, a common source of pain, by provoking the mechanism of tissue pinching.
The Anatomy of Shoulder Impingement
Shoulder impingement occurs when soft tissues are compressed in the narrow subacromial space, located beneath the acromion, which forms the roof of the shoulder. This space contains the tendons of the rotator cuff muscles, particularly the supraspinatus tendon, and the subacromial bursa.
The acromion, coracoid process, and coracoacromial ligament form the rigid coracoacromial arch. Normally, there is enough space between the arch and the head of the humerus for the tendons and bursa to glide freely. Impingement syndrome develops when this space is reduced, often due to inflammation, anatomical variations, or bone spurs.
When the arm moves overhead, the greater tuberosity of the humerus moves closer to the acromion. In impingement syndrome, this narrowing compresses and irritates the supraspinatus tendon and bursa, causing inflammation and pain during overhead activity. The Neer test is designed to physically narrow this space to replicate the patient’s discomfort.
Performing the Neer Impingement Test
The Neer Impingement Test is a passive maneuver, performed by the clinician without the patient’s muscular assistance. The patient is typically seated or standing with the arm relaxed at their side. The examiner stands next to the affected shoulder to stabilize structures and control the movement.
The clinician stabilizes the scapula (shoulder blade) by placing one hand on the patient’s shoulder, preventing upward rotation. This stabilization is important because it isolates the movement to the glenohumeral joint, ensuring the acromion remains fixed relative to the moving arm.
With the other hand, the examiner grasps the patient’s arm, usually above the elbow. Before elevation, the arm is internally rotated so the thumb points toward the floor, positioning the greater tuberosity of the humerus beneath the acromion.
The examiner then passively raises the arm forward and upward into full forward flexion. This forced elevation, combined with internal rotation and scapular stabilization, maximizes the compression of the supraspinatus tendon and bursa against the coracoacromial arch. The test concludes when the arm reaches maximum elevation or when the patient’s familiar pain is reproduced.
Interpreting Positive and Negative Findings
The interpretation of the Neer Impingement Test relies on the patient’s pain response during the passive movement. A positive test is indicated by the reproduction of the patient’s familiar shoulder pain as the arm is elevated, usually between 70 and 180 degrees of flexion. This pain is typically felt in the anterior or lateral shoulder, reflecting mechanical irritation of the subacromial structures.
A positive result suggests subacromial pathology, such as supraspinatus tendonitis or subacromial bursitis. It indicates that inflamed tissues within the subacromial space are susceptible to being pinched during overhead motion. Conversely, a negative test occurs when the patient reports no pain, suggesting subacromial compression is not the primary source of the issue.
While helpful for screening, the test is not definitive due to moderate specificity (around 58 to 63 percent). This means a positive result can occasionally occur without true impingement syndrome. However, the test is highly sensitive (around 78 to 79 percent), making it effective at ruling out the condition when the result is negative. For accurate diagnosis, clinicians combine the Neer test with a cluster of other physical examination maneuvers.