Neer's Test: Understanding, Interpretation, and Clinical Significance of a Positive Result

What is a positive Neer's test?

A positive Neer's test is a common orthopedic special test used to assess for subacromial impingement syndrome in the shoulder, indicated by the reproduction of pain during a specific passive maneuver that compresses the rotator cuff tendons and bursa against the acromion.

Understanding the Neer's Test

The Neer's test is a clinical assessment tool frequently employed by physical therapists, physicians, and other healthcare professionals to help identify the presence of shoulder impingement syndrome. This syndrome occurs when the tendons of the rotator cuff (particularly the supraspinatus) and/or the subacromial bursa become compressed and irritated as they pass through the subacromial space.

• Purpose and Clinical Context: The primary goal of the Neer's test is to provoke pain by mechanically compressing the structures within the subacromial space. It is one of several tests used in a comprehensive shoulder examination to pinpoint the source of a patient's shoulder pain and dysfunction.
• Impingement Syndrome Overview: Shoulder impingement is often characterized by pain during overhead activities, reaching behind the back, or sleeping on the affected side. It can range from mild inflammation (tendinitis, bursitis) to more severe conditions like rotator cuff tears.

How the Neer's Test is Performed

The Neer's test is a passive maneuver, meaning the examiner moves the patient's arm without active participation from the patient. This helps isolate the movement and prevent the patient from compensating.

• Patient Positioning: The patient is typically seated or standing, facing the examiner, with the affected arm relaxed at their side.
• Examiner Technique:
  1. The examiner stands beside the patient, stabilizing the scapula (shoulder blade) with one hand to prevent unwanted movement and isolate the glenohumeral joint. This stabilization is crucial for accurate results.
  2. With the other hand, the examiner grasps the patient's forearm or elbow.
  3. The examiner then passively internally rotates the patient's arm. This action brings the greater tuberosity of the humerus (where the rotator cuff tendons attach) closer to the anterior acromion.
  4. While maintaining internal rotation, the examiner passively flexes the arm overhead, moving it through the sagittal plane, bringing the arm into full elevation (up to 180 degrees) or until pain is elicited.
• Key Biomechanics: This specific combination of internal rotation and full flexion is designed to maximally narrow the subacromial space, thereby compressing the supraspinatus tendon and/or the subacromial bursa against the anterior-inferior aspect of the acromion and the coracoacromial ligament.

Interpreting a Positive Neer's Test

The interpretation of the Neer's test hinges on the patient's symptomatic response during the maneuver.

• Defining "Positive": A Neer's test is considered positive if the patient experiences a reproduction of their typical shoulder pain during the maneuver, particularly as the arm approaches full overhead flexion. The intensity and location of the pain should match the patient's reported symptoms.
• Clinical Significance: A positive Neer's test strongly suggests the presence of subacromial impingement syndrome. This could indicate:
  • Rotator Cuff Tendinopathy: Inflammation or degeneration of the rotator cuff tendons, especially the supraspinatus.
  • Subacromial Bursitis: Inflammation of the bursa located between the rotator cuff tendons and the acromion.
  • Less commonly, it can also be associated with rotator cuff tears, as the tear may be further irritated by compression.
• Differential Diagnosis: While indicative, a positive Neer's test is not definitive on its own. Other conditions, such as acromioclavicular joint pathology or biceps tendinopathy, can sometimes produce similar pain patterns, though the mechanism of pain reproduction in the Neer's test is specific to subacromial compression.

Limitations and Considerations

Like all orthopedic special tests, the Neer's test has its limitations and should be interpreted within a broader clinical context.

• Specificity and Sensitivity: The Neer's test has high sensitivity (meaning it's good at identifying individuals with the condition if it's present) but moderate specificity (meaning it can sometimes produce false positives). This highlights the need for a comprehensive assessment.
• Clinical Correlation: A positive Neer's test should always be correlated with the patient's history, symptom presentation, and the findings from other physical examination tests (e.g., Hawkins-Kennedy test, painful arc test, rotator cuff strength tests).
• Role in Diagnosis: It serves as a valuable piece of the diagnostic puzzle rather than a standalone definitive diagnosis.

Next Steps After a Positive Test

If you experience pain during a maneuver similar to the Neer's test or suspect shoulder impingement, it is crucial to seek professional medical advice.

• Professional Consultation: Consult with a healthcare provider such as a physical therapist, orthopedic surgeon, or sports medicine physician. They can conduct a thorough examination, confirm the diagnosis, and rule out other potential causes of shoulder pain.
• Further Evaluation: Depending on the findings, further diagnostic tests may be recommended, including:
  • Imaging Studies: X-rays (to assess bone spurs or acromial shape), MRI (to visualize soft tissues like tendons and bursa), or ultrasound.
  • Additional Physical Tests: Other specialized tests to differentiate between various shoulder pathologies.
• Management Strategies: Treatment for shoulder impingement typically involves:
  • Conservative Management: Rest, activity modification, anti-inflammatory medications, and physical therapy (focusing on pain management, restoring range of motion, strengthening the rotator cuff and scapular stabilizers, and improving posture).
  • Injections: Corticosteroid injections may be used to reduce inflammation and pain.
  • Surgical Intervention: In severe or recalcitrant cases, surgical decompression of the subacromial space may be considered.

Understanding the Neer's test empowers you to better comprehend the diagnostic process for shoulder pain and to engage more effectively with your healthcare team.