Painful Arc Test
- Fysiobasen
- Oct 4
- 2 min read
The Painful Arc Test is used to identify subacromial impingement syndrome. The test evaluates whether pain occurs during a specific arc of shoulder abduction, which may indicate compression of structures within the subacromial space.
It is important to note that a positive test alone is not diagnostic and must always be interpreted in the context of other clinical findings and patient history¹.
Technique
Patient position
The patient stands or sits with the arms at rest by the side.
Execution
The patient is instructed to abduct the arm in the scapular plane (about 30° anterior to the frontal plane).
Any pain during the movement should be reported.
If pain is present, the patient continues abduction as far as possible.
Typically, pain decreases at approximately 120° abduction.
The arm is then returned to neutral (adduction).
Interpretation
Positive test: Pain occurs between 60–120° abduction and subsides beyond 120°².
Negative test: Absence of pain in this range.
This pain arc suggests compression of the rotator cuff tendons or subacromial bursa against the acromion.
Diagnostic Accuracy
Parameter | Value |
Sensitivity | 0.33³,⁴ |
Specificity | 0.81³,⁴ |
+LR | 1.70³,⁴ |
–LR | 0.84³,⁴ |
The test shows low sensitivity, meaning it often misses true cases, but moderate specificity, making a positive finding clinically valuable.
Test Clusters
Because of its limitations, the Painful Arc Test is often combined with other special tests:
Hawkins-Kennedy Test
Infraspinatus Test
Interpretation of combinations⁵:
All three positive → +LR = 10.56 (strong probability of impingement)
All three negative → –LR = 0.17 (strong probability of ruling out impingement)
Two positive → +LR = 5.03 (moderate value)
Best combinations⁶:
Painful Arc + Empty Can + External Rotation Resistance → strong diagnostic accuracy
Painful Arc + External Rotation Resistance (both negative) → strong rule-out value
Clinical Significance
While the Painful Arc Test alone is weak in sensitivity, it gains diagnostic power when combined with other shoulder impingement tests.
A positive finding may indicate:
Subacromial impingement
Rotator cuff tendinopathy
Subacromial bursitis
Differential diagnoses:
Pain <60° abduction → possible AC joint pathology
Pain >120° abduction → may suggest cervical radiculopathy or glenohumeral instability
If clinical suspicion remains despite a negative test, imaging (ultrasound, MRI) should be considered.
Summary
The Painful Arc Test is a simple, commonly used screening tool for subacromial impingement.
Positive result: Pain in 60–120° abduction.
Strength: Moderate specificity.
Limitation: Low sensitivity, not sufficient alone.
Best use: As part of a cluster with other impingement tests for improved accuracy.
References
Cyriax J. Textbook of orthopaedic medicine: Volume one diagnosis of soft tissue lesions 8 th ed. London: Bailliere Tindall. 1984:59-60.
Flynn, T.W., Cleland, J.A., & Whitman, J.M. (2008). User's guide to the musculoskeletal examination: Fundamentals for the evidence-based clinician. Buckner, Kentucky: Evidence in Motion
Calis, M., Akgun, K., Birtane, M., et al. (2000). Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. Ann Rheum Dis, 59, 44-47.
Çalış M, Akgün K, Birtane M, Karacan I, Çalış H, Tüzün F. Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. Annals of the rheumatic diseases. 2000 Jan 1;59(1):44-7.
Park, H.B., Yokota, A., Gill, H.S., EI RG, McFarland, E.G. (2005). Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg Am, 87(7), 1446-1455.
Chen CW, Pan ZE, Zhang C, Liu CL, Chen L. Zhongguo Gu Shang. 2016;29(5):434-438.
