Neer Test: Purpose, Procedure, and Clinical Significance

What is the Neer test?

The Neer test is a common orthopedic special test used to assess for subacromial impingement syndrome in the shoulder, particularly involving the supraspinatus tendon and subacromial bursa. It aims to provoke pain by passively forcing the greater tuberosity of the humerus against the anterior-inferior aspect of the acromion.

Understanding the Neer Test

The Neer test, named after Dr. Charles S. Neer II, is a clinical examination maneuver designed to help diagnose subacromial impingement syndrome of the shoulder. Impingement occurs when soft tissues (like tendons of the rotator cuff, particularly the supraspinatus, and the subacromial bursa) are compressed between the humeral head and the acromion, especially during overhead movements. This compression can lead to inflammation, pain, and, if chronic, tendon degeneration. The Neer test specifically attempts to reproduce this impingement by mechanically narrowing the subacromial space.

Anatomical Basis: Why the Shoulder is Vulnerable

To understand the Neer test, it's crucial to grasp the relevant shoulder anatomy:

• Acromion: A bony projection from the scapula (shoulder blade) that forms the roof of the shoulder joint.
• Humeral Head: The ball-shaped top of the humerus (upper arm bone) that articulates with the glenoid fossa of the scapula.
• Greater Tuberosity: A prominent bony landmark on the humerus where the supraspinatus, infraspinatus, and teres minor tendons attach.
• Subacromial Space: The narrow area between the acromion and the humeral head. This space contains the rotator cuff tendons (especially the supraspinatus) and the subacromial bursa, which acts as a cushion to reduce friction.

During overhead arm movements, the greater tuberosity can abut against the acromion, especially if the subacromial space is already compromised due to inflammation, bone spurs, or abnormal scapular kinematics. The Neer test intentionally replicates this mechanical compression.

How the Neer Test is Performed

The Neer test is performed by an examiner and requires specific positioning:

1. Patient Position: The patient is typically seated or standing, facing the examiner, with their arm relaxed at their side.
2. Examiner Position: The examiner stands beside the patient, supporting the shoulder to stabilize the scapula and prevent compensatory movements.
3. Procedure:
   • The examiner grasps the patient's elbow with one hand and stabilizes the scapula (or shoulder) with the other hand to prevent scapular rotation and ensure isolated glenohumeral motion.
   • The examiner then passively and maximally internally rotates the patient's arm. This maneuver brings the greater tuberosity forward, positioning the supraspinatus tendon in a way that maximizes its potential for impingement.
   • While maintaining internal rotation, the examiner passively flexes the patient's arm overhead, moving it through the full arc of motion up to 180 degrees (or until pain is elicited). The goal is to bring the arm into full elevation.

Interpreting the Results: What a Positive Test Means

A Neer test is considered positive if the patient experiences pain, particularly sharp pain, in the anterior or lateral aspect of the shoulder during the passive overhead flexion, especially when the arm is internally rotated.

• Pain Location: The pain is typically felt in the region of the subacromial space, often radiating down the deltoid.
• Pain Quality: The pain is usually described as a sharp, pinching, or catching sensation, indicating mechanical compression of the inflamed structures.
• Implication: A positive Neer test suggests the presence of subacromial impingement syndrome, which could involve the supraspinatus tendon, the subacromial bursa, or both.

Clinical Significance and Limitations

The Neer test is a widely used and valuable tool in the initial assessment of shoulder pain, but it's important to understand its context:

• Sensitivity and Specificity: The Neer test is generally considered to have high sensitivity (meaning it's good at identifying individuals who do have impingement), but lower specificity (meaning a positive result doesn't exclusively point to impingement, as other conditions can also cause pain with this movement).
• Differential Diagnosis: While a positive Neer test strongly suggests impingement, it cannot definitively differentiate between rotator cuff tendinopathy, bursitis, or a partial rotator cuff tear. Further tests and imaging (like MRI) are often required for a precise diagnosis.
• Non-Specific Pain: Pain during the test can also be caused by conditions unrelated to impingement, such as AC joint pathology or referred pain.
• Part of a Cluster: The Neer test is most effective when used as part of a cluster of orthopedic tests (e.g., Hawkins-Kennedy test, Painful Arc test, Empty Can test) and in conjunction with a thorough patient history and physical examination. No single test is diagnostic in isolation.

Beyond the Neer Test: Comprehensive Assessment

For fitness enthusiasts, personal trainers, or student kinesiologists, understanding the Neer test provides insight into how shoulder impingement is clinically assessed. However, it's crucial to remember that a single test does not provide a complete picture. A comprehensive assessment by a qualified healthcare professional (physician, physical therapist) involves:

• Detailed History: Understanding the onset, nature, aggravating factors, and relieving factors of the pain.
• Observation: Assessing posture, muscle atrophy, and scapular dyskinesis.
• Range of Motion: Active and passive range of motion assessment.
• Palpation: Identifying tender areas.
• Strength Testing: Assessing the strength of the rotator cuff and periscapular muscles.
• Other Special Tests: Performing additional tests to rule in or rule out other conditions (e.g., instability, labral tears, nerve entrapment).
• Imaging: X-rays, MRI, or ultrasound may be used to confirm diagnosis and assess the extent of tissue damage.

Who Benefits from this Test?

The Neer test is primarily utilized by healthcare professionals, including:

• Orthopedic Surgeons: To diagnose shoulder pathologies.
• Physical Therapists/Physiotherapists: For differential diagnosis and guiding rehabilitation strategies.
• Chiropractors: As part of their musculoskeletal assessment.
• Sports Medicine Physicians: To evaluate athletes with shoulder pain.

While fitness professionals should be aware of such tests for educational purposes and to understand potential client limitations, they should not perform diagnostic tests or attempt to diagnose medical conditions. Their role is to refer clients experiencing pain or suspected injury to appropriate healthcare providers.

Important Note

This article is for informational and educational purposes only and does not constitute medical advice. If you are experiencing shoulder pain or suspect you have an injury, consult with a qualified healthcare professional for an accurate diagnosis and appropriate treatment plan. Self-diagnosis and treatment can be dangerous.