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Neer Test – Diagnosing Shoulder Impingement
The Neer Test is a clinical examination used to diagnose shoulder impingement syndrome. It helps doctors detect tendon entrapment within the shoulder joint.
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The Neer Test is a clinical examination used to diagnose shoulder impingement syndrome. It helps doctors detect tendon entrapment within the shoulder joint.
What is the Neer Test?
The Neer Test (also known as the Neer Sign) is a clinical provocation test used in orthopedic and sports medicine examinations. It is designed to detect shoulder impingement syndrome – a painful condition in which soft tissues such as tendons or bursae become compressed within the shoulder joint. The test was named after American orthopedic surgeon Charles S. Neer, who first described it in the 1970s.
Background: Shoulder Impingement Syndrome
Shoulder impingement syndrome occurs when the tendons of the rotator cuff – a group of four muscles and their tendons that stabilize the shoulder joint – become compressed beneath the acromion (the bony roof of the shoulder). This leads to pain, especially during arm elevation, and can result in long-term tendon degeneration or tears if left untreated.
How is the Neer Test Performed?
The test is typically performed by a physician or physiotherapist and requires no technical equipment. The procedure is straightforward and standardized:
- The patient is seated or standing upright.
- The examiner stabilizes the scapula (shoulder blade) with one hand to prevent compensatory movement.
- With the other hand, the examiner passively raises the patient's straightened arm in forward flexion, with the arm internally rotated and the thumb pointing downward.
- The arm is slowly elevated above the horizontal plane.
- A positive test result is recorded when the patient reports pain in the shoulder area, typically at the front or outer side of the shoulder.
Clinical Significance and Reliability
A positive Neer Test suggests the presence of impingement syndrome, but does not confirm it on its own. The sensitivity (ability to identify those with the condition) of the test is approximately 72–79%, while the specificity (ability to correctly rule out the condition in healthy individuals) is around 66–68%. The test is therefore always used in combination with other clinical tests such as the Hawkins-Kennedy Test or the Empty Can Test, as well as imaging studies (e.g., ultrasound or MRI).
Variant: Neer Injection Test
An extension of the Neer Test is the Neer Injection Test: a local anesthetic is injected into the subacromial space. If this injection leads to significant pain relief and the Neer Test subsequently becomes negative, it serves as additional confirmation of subacromial impingement syndrome.
When Should the Neer Test Be Used?
The test is indicated in patients with:
- Pain during arm elevation (particularly between 60° and 120° of elevation)
- Persistent shoulder pain without a clear cause
- Suspected rotator cuff pathology
- Shoulder complaints following repetitive overhead movements (e.g., in swimmers, throwers, or manual workers)
Limitations of the Test
The Neer Test can also yield positive results in other shoulder conditions, such as biceps tendinopathy or acromioclavicular joint arthritis. A thorough clinical examination and patient history are therefore essential for accurate diagnosis.
References
- Neer CS 2nd. Impingement lesions. Clinical Orthopaedics and Related Research. 1983;173:70–77.
- Hegedus EJ et al. Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. British Journal of Sports Medicine. 2008;42(2):80–92.
- Magee DJ. Orthopedic Physical Assessment. 6th ed. Elsevier Saunders; 2014.
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