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Subacromial Impingement Examination Tests

cross-body adduction test drop-arm sign empty can external rotation resistance hawkins-kennedy lift-off test neer's sign orthopaedic special tests painful arc rotator cuff related pain shoulder pain subacromial impingement
Subacromial Impingement Examination Tests, Neer Test

Subacromial Impingement Examination Tests 

Hawkins-Kennedy test: Shoulder is flexed to 90 degrees and then internally rotated with elbow flexed to 90 degrees. Positive test indicates pain with internal rotation.

  • One meta-analysis reported a sensitivity of 79% and specificity of 59%.1
  • Another study by Calis et al. found a sensitivity of 92.1% and specificity of 25%.2
  • The pooled estimates of sensitivity and specificity were 74% (95% CI 57 to 85) and 57% (95% CI 46 to 67). The pooled positive likelihood ratio was 1.70 (95% CI 1.29 to 2.26) and the pooled negative likelihood ratio was 0.46 (95% CI 0.27 to 0.78).4

 

Neer’s sign: Examiner stabilizes the scapula and flexes shoulder until pain is felt or end of ROM. A positive test is pain with flexion.

  • The pooled estimates of sensitivity and specificity were 78% (95% CI 68 to 87%) and 58% (95% CI 47 to 68). The pooled positive likelihood ratio was 1.86 (95% CI 1.49 to 2.31) and the pooled negative likelihood ratio was 0.37 (95% CI 0.25 to 0.55).3,4

 

Painful arc:  The shoulder is elevated in scapular plane abduction to full elevation and then lowered in the same motion. A positive test is pain or pain from 60 to 120 degrees scapular plane abduction.

  • Hedgedus et al. (2012) revealed a sensitivity of 53%and specificity of 76%.4

 

Empty can test:  The shoulder is abducted to 90 degrees and slightly adducted.  The shoulder is internally rotated and downward force applied. A positive test is pain or inability to maintain abduction.

  • The pooled estimates of sensitivity and specificity were 69% (95% CI 54 to 81%) and 62% (95% CI 38 to 81). The pooled positive likelihood ratio was 1.81 (95% CI 1.16 to 2.83) and the pooled negative likelihood ratio was 0.50 (95% CI 0.40 to 0.63).4

 

Lift-off test:  The patient is standing with the shoulder internally rotated and extended, and the elbow flexed. The dorsal surface of the hand is placed against the midlumbar spine. The examiner asks the patient to lift the hand away from the back.

  • The pooled estimates of sensitivity and specificity were 42% (95% CI 19 to 69) and 97% (95% CI 79 to 100). The pooled positive likelihood ratio was 16.47 (95% CI 1.43 to 185.61) and the pooled negative likelihood ratio was 0.59 (95% CI 0.37 to 0.97).4

 

External rotation resistance: The elbow flexed to 90 degrees and adducted to the trunk of the body with neutral rotation.  The patient attempts to resist a medially directed force. A positive test is pain.

  • The sensitivity of external rotation resistance for subacromial impingement is 0.56, and the specificity is 0.87.5,6

 

Cross-body adduction test:  The shoulder is elevated to 90 degrees and adducted across the body. A positive test is pain with adduction.

  • The cross-body adduction test has a sensitivity of 23% and a specificity of 82% for subacromial impingement.5,6 

 

Drop arm sign:  The shoulder is elevated to full flexion and asked to slowly lower. A positive test is severe pain or inability to slowly lower.

  • The pooled estimates of sensitivity and specificity were 21% (95% CI 14 to 30) and 92% (95% CI 86 to 96). The pooled positive likelihood ratio was 2.62 (95% CI 1.60 to 4.30) and the pooled negative likelihood ratio was 0.86 (95% CI 0.79 to 0.94).4



  1. Phillips N. Tests for diagnosing subacromial impingement syndrome and rotator cuff disease. Shoulder Elbow. 2014;6(3):215-221. doi:10.1177/1758573214535368
  2. Caliş M, Akgün K, Birtane M, Karacan I, Caliş H, Tüzün F. Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. Ann Rheum Dis. 2000;59(1):44-47. doi:10.1136/ard.59.1.44
  3. Alqunaee M, Galvin R, Fahey T. Diagnostic accuracy of clinical tests for subacromial impingement syndrome: a systematic review and meta-analysis. 2012. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.
  4. Hegedus EJ, Goode AP, Cook CE, et al. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med. 2012;46(14):964-978. doi:10.1136/bjsports-2012-091066
  5. Michener LA, Walsworth MK, Doukas WC, Murphy KP. Reliability and diagnostic accuracy of 5 physical examination tests and combination of tests for subacromial impingement. Arch Phys Med Rehabil. 2009;90(11):1898-1903. doi:10.1016/j.apmr.2009.05.015
  6. Park HB, Yokota A, Gill HS, El Rassi G, McFarland EG. Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg Am. 2005;87(7):1446-1455. doi:10.2106/JBJS.D.02335

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