What is a Neer Test
The Neer test is a physical examination maneuver that detects subacromial impingement syndrome by passively elevating the patient's arm in full forward flexion (between 70-120°), which reproduces pain when the supraspinatus tendon impinges against the coracoacromial arch. 1, 2
Test Technique
The examiner passively moves the patient's arm into full forward flexion while stabilizing the scapula. 3 Pain elicited during this maneuver, particularly between 70-120° of elevation, constitutes a positive test. 1
Diagnostic Performance
The Neer test has 88-89% sensitivity for detecting subacromial impingement syndrome, making it an excellent screening tool to rule out the condition when negative. 1, 2, 4
However, specificity is poor at only 33-53%, meaning many patients without true impingement will test positive. 2, 4
The positive predictive value is limited due to low specificity, so a positive test alone cannot confirm the diagnosis. 4
The negative predictive value is strong—a negative Neer test effectively rules out subacromial impingement (negative likelihood ratio 0.35). 5
Clinical Interpretation
The Neer test works best as a screening tool rather than a confirmatory test. 2, 5 When negative, it effectively excludes impingement syndrome. 5
For definitive diagnosis, imaging studies (ultrasound or MRI) are required, as the Neer test only detects impingement as a pathogenic process, not the specific anatomic lesion. 2
Combining the Neer test with other examination maneuvers improves diagnostic accuracy—having 3 or more positive tests out of 5 standard impingement tests (Neer, Hawkins-Kennedy, painful arc, empty can, external rotation resistance) confirms the diagnosis. 5
Reliability Considerations
Inter-observer reproducibility of the Neer test is good (kappa 0.64), making it reliable when performed by different examiners. 6
Intra-observer reproducibility is somewhat lower (poor by kappa coefficient), suggesting results may vary when the same examiner repeats the test. 6
Clinical Context
The test reproduces the mechanical impingement that occurs with repetitive overhead activities, where the supraspinatus tendon gets compressed between the humeral head and coracoacromial arch during combined abduction and internal rotation. 3, 2 This mechanism is particularly relevant in athletes and manual laborers with repetitive overhead arm use. 2
Common pitfall: Do not use the Neer test alone to confirm subacromial impingement—its poor specificity means many false positives will occur. 2, 4 Always correlate with other physical examination findings and consider imaging for definitive diagnosis. 2