Neer TestEdit

The Neer test, sometimes called the Neer impingement sign, is a clinical maneuver used in the evaluation of shoulder pain to help identify subacromial impingement and related rotator cuff pathology. Named for a clinician who described the sensation of impingement within the subacromial space, the test has become a staple of the sport medicine and orthopedic examination repertoire. It is most commonly employed in conjunction with a broader shoulder assessment, radiographs, and, when indicated, advanced imaging such as magnetic resonance imaging or ultrasound to refine the diagnosis.

The test targets the subacromial space where the supraspinatus tendon and nearby bursae can become compressed during arm elevation. While a positive result can point toward impingement or tendinopathy, it is not perfectly specific and should be interpreted within the broader clinical context, including patient history, examination of other provocative maneuvers, and imaging findings if necessary. The Neer test remains widely used by primary care physicians, sports medicine specialists, and surgeons as part of a systematic approach to shoulder disorders shoulder disorders.

History

The Neer test is part of a family of provocative shoulder tests developed in the mid- to late-20th century to characterize mechanical pain patterns in the shoulder. Its development is associated with work on shoulder impingement and rotator cuff disease, and it has since been incorporated into standard examination scripts for patients with anterior or lateral shoulder pain. The test is frequently discussed alongside other maneuvers such as the Hawkins-Kennedy test and the empty can test as components of a comprehensive assessment for rotator cuff pathology and impingement syndromes.

Indications and clinical context

Suspected subacromial impingement or rotator cuff tendinopathy in a patient with shoulder pain, especially when symptoms are aggravated by overhead activities.
Evaluation of mechanical shoulder pain where inflammatory conditions of the glenohumeral joint are less likely, and where radiographs are being used to assess bony abnormalities.
Part of a broader shoulder exam in settings such as primary care, sports medicine, physical rehabilitation, and orthopedic clinics.
Used in conjunction with imaging and other clinical tests to differentiate impingement from conditions like adhesive capsulitis, bicipital tendinopathy, or glenohumeral joint pathology.

Technique

The patient is typically seated or standing with the arm in a position that places the rotator cuff under the acromion. The examiner stabilizes the scapula to prevent compensatory movement from the trunk.
The arm is positioned for internal rotation (palm facing downward) and then moved into forward flexion by the examiner to place the greater tubercle of the humerus under the acromial arch.
The examiner gently but firmly brings the arm into complete forward flexion, aiming to compress the subacromial space as much as tolerable for the patient.
A positive test is the reproduction of anterior- or lateral-shoulder pain that the patient associates with impingement.

Notes on interpretation: The sign relies on provocative compression of the structures beneath the acromion, including the supraspinatus tendon and subacromial bursa. It may be influenced by the patient’s age, activity level, and the presence of degenerative changes. The technique is operator-dependent, and differences in stabilization or limb positioning can affect the result. For a more robust assessment, clinicians often perform it alongside other tests and consider the overall clinical picture rather than relying on a single sign.

Interpretation and related concepts

A positive Neer test suggests impingement-related pathology, most commonly subacromial impingement or supraspinatus tendinopathy, but it can also be elicited by other causes of anterior shoulder pain such as bicipital tendinopathy or degenerative changes in the acromiohumeral joint.
Sensitivity and specificity vary across studies, and the test is generally viewed as a helpful component of a multi-test assessment rather than a definitive diagnostic tool. In practice, clinicians report higher sensitivity for detecting impingement when the Neer sign is combined with other provocative maneuvers, such as the Hawkins-Kennedy test or the empty can test.
Imaging—most often MRI or ultrasound—is used to confirm tendon integrity, bursitis, or other pathology if the clinical picture remains uncertain after examination.

Controversies and debates

Diagnostic specificity: Critics note that while the Neer test is useful for identifying a painful production related to the subacromial space, it does not reliably distinguish impingement from other shoulder disorders. The same maneuver can evoke pain in patients with tendonopathy, capsulitis, or other soft-tissue conditions that affect the shoulder girdle. As a result, many clinicians emphasize an integrated approach rather than relying on a single sign.
Pathophysiological debates: In recent years there has been discussion in the literature about the primacy of mechanical impingement versus tendinopathy as the dominant mechanism of rotator cuff disease. Some experts argue that what is traditionally labeled “impingement” may reflect a spectrum that includes intrinsic degenerative changes, with the Neer test capturing a painful manifestation rather than a discrete disease category. This debate is mirrored in practice by variability in how aggressively imaging is used to bolster or refine physical examination findings.
Teaching and standardization: Given the technique’s operator dependence, there is ongoing discussion about how best to teach and standardize the maneuver in medical education. Practice guidelines often stress that the Neer test should be used as part of a broader exam repertoire rather than as a stand-alone determinant of diagnosis.