How to perform the Neer (Named after Charles Neer) test?

From the Guidelines

The Neer test is performed by passively raising the patient's straightened arm in forward flexion, while stabilizing the scapula, to diagnose shoulder impingement syndrome, with pain typically occurring between 70 and 120 degrees of elevation, as described in the study by 1. To perform the test, have the patient seated or standing with their arm relaxed. Stand behind or beside the patient and use one hand to stabilize the scapula by placing it on the top of the shoulder. With your other hand, grasp the patient's elbow and passively raise their straightened arm in forward flexion (moving the arm forward and upward). While doing this, prevent the scapula from rotating by maintaining pressure with your stabilizing hand. Some key points to consider when performing the Neer test include:

• The test is sensitive (88 percent) but not specific (33 percent) for impingement, as noted in the study by 1.
• The patient's arm should be straightened and passively raised to minimize voluntary muscle contraction.
• The scapula should be stabilized to ensure accurate test results.
• The test should be performed gently and stopped immediately if the patient reports significant pain.
• The Neer test is often used alongside other shoulder examination techniques to confirm a diagnosis of shoulder impingement.

From the Research

Neer Test Procedure

To perform the Neer test, the following steps can be taken:

• The patient stands or sits with their arm relaxed by their side 2, 3, 4.
• The examiner then passively elevates the patient's arm in the sagittal plane, applying gentle pressure to the top of the shoulder to assess for any pain or resistance 2, 3, 4.
• A positive test is indicated by pain or tenderness in the subacromial region, suggesting subacromial impingement syndrome 2, 3, 4.

Diagnostic Accuracy

The diagnostic accuracy of the Neer test for subacromial impingement syndrome is as follows:

• The Neer test has a sensitivity of 80% and specificity of 52% 5.
• The test has a positive likelihood ratio of 1.67 and a negative likelihood ratio of 0.35 3, 4.
• The diagnostic accuracy rate of the Neer test in identifying shoulder subacromial impingement syndrome is 74% 5.

Comparison with Other Tests

The Neer test can be compared with other tests for subacromial impingement syndrome, including:

• Hawkins-Kennedy test: has a lower sensitivity and specificity than the Neer test 3, 4.
• Painful arc test: has a higher sensitivity and specificity than the Neer test 3, 4.
• Empty can test: has a higher sensitivity and specificity than the Neer test 3, 4.
• External rotation resistance test: has a higher sensitivity and specificity than the Neer test 3, 4.