Neer’s Test
- Fysiobasen
- Oct 4
- 2 min read
Neer’s Test is frequently used to identify subacromial impingement syndrome. It is a standard component of the clinical shoulder examination and is designed to provoke symptoms associated with subacromial pathology.
Technique
Patient position:The patient may be seated or standing.
Execution:
The examiner stabilizes the patient’s scapula with one hand to prevent compensatory movement.
With the other hand, the examiner passively elevates the patient’s arm into forward flexion, while maintaining the shoulder in internal rotation.
The test is considered positive if the patient reports pain in this position.
This maneuver compresses the supraspinatus tendon and subacromial bursa against the anterior acromion, thereby provoking symptoms if impingement is present.
Interpretation of Results
Positive test: Suggests subacromial impingement, often associated with inflammation of the rotator cuff or subacromial bursa.
Negative test: Reduces the likelihood of impingement but does not rule it out.
It is important to note that Neer’s Test alone is not diagnostic and should always be interpreted in combination with other impingement tests.
Evidence
Reported diagnostic properties¹:
Parameter | Reported Range | Clinical Interpretation |
Sensitivity | 0.00 – 0.93 | Highly variable; occasionally strong for detecting impingement |
Specificity | 0.31 – 1.00 | Very inconsistent across studies |
Positive LR | 1.30 – 1.35 | Low to moderate value in confirming impingement |
Negative LR | 0.37 – 0.82 | Some utility in ruling out impingement if negative |
Meta-analyses of diagnostic accuracy²,³:
Author | Sensitivity | Specificity |
Hegedus et al. (2008) | 0.79 | 0.53 |
Hegedus et al. (2012) | 0.72 | 0.60 |
These analyses indicate that Neer’s Test demonstrates moderate sensitivity but only low to moderate specificity. This reinforces the importance of combining Neer’s Test with other shoulder impingement tests, such as the Hawkins-Kennedy Test, Painful Arc Sign, or Infraspinatus Test, to strengthen diagnostic accuracy.
Summary
Neer’s Test is a useful screening tool for detecting subacromial impingement.
Alone it lacks diagnostic precision, due to inconsistent sensitivity and specificity.
Best applied as part of a cluster of impingement tests, improving the reliability of diagnosis in patients with suspected rotator cuff or subacromial pathology.
References
Dutton, M. (2008). Orthopaedic: Examination, evaluation, and intervention (2nd ed.). New York: The McGraw-Hill Companies, Inc.
Hegedus, E. J., Goode, A., Campbell, S., Morin, A., Tamaddoni, M., Moorman, C. T., Cook, C. (2008). Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. British journal of sports medicine, 42(2), 80-92.
Hegedus, E. J., Goode, A. P., Cook, C. E., Michener, L., Myer, C. A., Myer, D. M., Wright, A. A. (2012). Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. British journal of sports medicine, 46(14), 964-978.
