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The Neer Test, sometimes called Neer's Test, is an orthopedic examination used to test for subacromial impingement of the rotator cuff tendons, also known as Subacromial Pain Syndrome or Impingement Syndrome. The test is conducted with the patient in a relaxed standing position, and the examiner moves the patient's arm through a full range of motion. The Neer Test is considered positive if the patient reports pain in the anterior-lateral aspect of the shoulder, indicating possible degenerative tendonitis or tendon ruptures.
| Characteristics | Values |
|---|---|
| Test Name | Neer Test/Neer's Test |
| Test Type | Orthopedic examination of the shoulder |
| Purpose | To test for subacromial impingement of rotator cuff tendons |
| Test Position | Patient stands relaxed with the arm to be tested at their side and the elbow fully extended |
| Test Movement | Examiner internally rotates the patient's arm and forcefully moves it through a full range of forward flexion |
| Positive Test Result | Pain in the anterior-lateral aspect of the shoulder |
| Test Focus | Supraspinatus tendon, with potential involvement of the anterior infraspinatus and long head of biceps |
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What You'll Learn
Orthopedic shoulder examination
Shoulder pain is one of the most common complaints in outpatient settings, often related to trauma from sports or accidents, or caused by degenerative joint disease and arthritis. An orthopedic examination of the shoulder can help confirm the presence of a shoulder lesion.
The Neer Test is a common test used in the orthopedic examination of the shoulder. It is used to test for subacromial impingement of rotator cuff tendons, also known as Subacromial Pain Syndrome or Impingement Syndrome. The patient is positioned standing with the arm to be tested relaxed at the side of the body and the elbow fully extended. The examiner then forcefully moves the arm through a full range of forward flexion. The test is considered positive if pain is reported in the anterior-lateral aspect of the shoulder.
The shoulder examination should begin with a general inspection, looking for any functional impairments of the shoulder joint and musculoskeletal abnormalities or associated functional deficits. The examiner should inspect the front, back, and side of the shoulder. Before proceeding, a full examination of the cervical spine should be completed to rule out any spinal pathologies that may be contributing to the presentation. This includes checking for cervical spinal tenderness and the range of motion of the neck in flexion, extension, and rotation.
The range of motion (ROM) of the shoulder should then be tested in different directions. The patient should start with the forearm fully extended at the elbow, with the arm attached to the side of the trunk, and then flex the arm at the shoulder, moving the upper extremity anteriorly and then superiorly until it is above their head. If movement in a specific direction is painful or limited, this may indicate that pathology is present in a specific structure of the shoulder.
Another test that can be performed is Speed's test, where the patient first flexes the elbow at 90 degrees and partially pronates the forearm. The patient then supinates the forearm against the resistance of the examiner, who palpates the origin of the biceps tendon for any tenderness or popping sensation. The test is considered positive if pain is elicited.
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Rotator cuff impingement
The Neer Test is a common test in the orthopedic examination of the shoulder. It is used to test for subacromial impingement of the rotator cuff tendons, also known as Subacromial Pain Syndrome or Impingement Syndrome. The test is conducted with the patient standing in a relaxed position. The examiner then moves the patient's arm passively, starting with the arm relaxed at the side of the body and the elbow fully extended, and forcefully moving the arm through the full range of forward flexion. The test is considered positive if pain is reported in the anterior-lateral aspect of the shoulder.
The treatment goals for rotator cuff impingement aim to reduce pain and restore function. Initial treatment options include rest, medications, and physical therapy. Physiotherapists can suggest exercises to improve the range of motion and reduce pain. Steroid injections may be considered if conservative measures are ineffective. These injections deliver steroids, potent anti-inflammatory medications, into the bursa beneath the acromion to alleviate inflammation and pain. In cases where non-surgical treatments fail to provide relief, surgery may be recommended to increase the space around the tendon and prevent further impingement.
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Subacromial impingement
The subacromial space is normally 1.0 to 1.5 cm wide, but in people with subacromial impingement syndrome, this space narrows due to the superior migration of the humeral head. This narrowing results in the humeral head applying compressive force to either the rotator cuff, the subacromial bursa, or both structures, causing pain and reduced range of motion. Repetitive pathologic compression, degeneration, and fraying of the rotator cuff tendons are believed to contribute to the narrowing of the subacromial space, but it is unclear if the inflamed and damaged tendons cause the impingement or if the narrowed subacromial space causes tendon inflammation.
The Neer Test, also known as Neer's Test, is a common orthopedic examination used to diagnose subacromial impingement syndrome. The test is simple and reliable and is performed with the patient standing relaxed with their arm by their side and their elbow fully extended. The examiner then internally rotates the patient's arm and forcefully moves it through a full range of forward flexion. If the patient reports pain in the anterior-lateral aspect of the shoulder, the test is considered positive for subacromial impingement. The Neer Test is believed to be more accurate than the Hawkins Test for diagnosing subacromial impingement, although some studies have found the reverse to be true.
The treatment for subacromial impingement syndrome typically involves conservative management with analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), and regular physiotherapy. In some cases, corticosteroid injections into the subacromial space may be trialled. Early diagnosis and appropriate education on warm-up techniques and monitoring for worsening impingement are crucial for successful management.
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Shoulder impingement tests
The Neer Test, sometimes called Neer’s Test, is a common orthopedic examination of the shoulder. It is used to test for subacromial impingement of the rotator cuff tendons, also known as Subacromial Pain Syndrome or Impingement Syndrome. The test is considered positive if pain is reported in the anterior-lateral aspect of the shoulder.
The Neer Test is quite simple to conduct. The patient is positioned standing with their arm relaxed at the side of the body and the elbow fully extended. The examiner then internally rotates the patient's arm and forcefully moves the arm through its full range of forward flexion. Alternatively, the patient can perform this movement actively, by passively flexing their affected humerus through its range.
The Neer Test is considered by some to be a more accurate test for shoulder impingement than the Hawkins Test, though some studies have found the reverse to be true. Both tests have high sensitivity but lower specificity, which diminishes their discrimination ability for subacromial impingement.
It is important to remember that in subacromial impingement, as the arm is elevated in the scapular plane, there is a decrease in the space between the greater tuberosity of the humerus and the acromion. This means that critical areas of the supraspinatus tendon, and occasionally the long head of the biceps, pass under the coraco-acromial ligament or anterior acromion. As a result, patients with subacromial impingement can experience pain with arm internal or external rotation.
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Overuse injury to the supraspinatus tendon
The Neer Test is a common orthopedic examination of the shoulder that is used to test for subacromial impingement of rotator cuff tendons, also known as Subacromial Pain Syndrome or Impingement Syndrome. The test is conducted with the patient standing in a relaxed position. The examiner then moves the patient's arm through a full range of forward flexion. The test is considered positive if the patient reports pain in the anterior-lateral aspect of the shoulder.
The Neer Test is often used to diagnose rotator cuff tendon overuse injuries, which are a common degenerative disorder that can result in pain and limited range of motion. Athletes and laborers who perform repetitive overhead motions are particularly susceptible to this type of injury, as are older adults. If left untreated, rotator cuff tendon overuse injuries can lead to full or partial-thickness tears that may require surgical intervention.
The etiology of rotator cuff tendon overuse injuries is not yet fully understood, and it is unclear how this type of injury affects other components of the glenohumeral joint, such as the nearby articular cartilage. However, studies have shown that overuse of the supraspinatus tendon can lead to degenerative changes in the tendon insertion region and adjacent humeral cartilage. In a rat model of supraspinatus tendon overuse, histological scoring revealed tendinopathic cellular and collagen fiber changes after 10 weeks of overuse when compared to controls. EPIC-μCT imaging also demonstrated significant cartilage thinning, decreased proteoglycan content, and increased subchondral bone thickness in the overuse group.
These findings suggest that rotator cuff tendon overuse can affect the matrix integrity of both the supraspinatus tendon and nearby humeral articular cartilage. Cysteine cathepsins K and L have been implicated in collagen degradation in tendon overuse injuries, and cathepsin K has been shown to make collagen more susceptible to further degradation by other proteases. Understanding the underlying mechanisms of early tendon injury is important for developing new interventions to prevent tendon rupture.
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