Neer Test for Shoulder Impingement: Procedure, Purpose, and Clinical Use

Shoulder pain is one of the most common musculoskeletal complaints encountered in physical therapy, often impacting functional movement and daily activities. When a patient presents with anterior or lateral shoulder pain during overhead motion, determining whether subacromial structures are involved becomes an important step in clinical reasoning. The neer test is one of several orthopedic special tests used to assess for subacromial impingement and can help guide evaluation and treatment planning.

This article outlines the purpose and procedure of the neer test, reviews its clinical utility and limitations, and provides a practical example of its use during a patient session. You’ll also learn how the neer test fits into a broader shoulder examination to help support informed decision-making.

What Is the Neer Test?

The neer test was developed by Dr. Charles Neer in the 1970s to identify signs of mechanical impingement within the subacromial space. During this test, the shoulder is passively flexed while in internal rotation. If this maneuver elicits pain, it may indicate that the supraspinatus tendon, long head of the biceps tendon, or subacromial bursa is being compressed against the anterior acromion or coracoacromial arch¹.

It is important to remember that while the test can help reproduce symptoms consistent with impingement, it does not confirm the exact tissue involved. Instead, it serves as one part of a larger clinical picture.

How to Perform the Neer Test

To administer the neer test accurately, follow these steps:

1. Patient position: Seated or standing, with arms relaxed at the side.

2. Examiner position: Stand beside the patient on the side being tested.

3. Stabilize the scapula: Use one hand to prevent upward rotation of the scapula.

4. Internally rotate the arm: Position the patient’s arm with the thumb pointing downward (internal rotation).

5. Passive flexion: With your opposite hand, move the arm into forward flexion in the sagittal plane until it is fully overhead.

A positive test occurs when the patient experiences pain in the anterior or lateral shoulder during this maneuver¹².

Clinical Interpretation and Limitations

What a Positive Test Means

A positive neer test suggests mechanical irritation of structures within the subacromial space. These may include:

• Supraspinatus tendon

• Long head of the biceps tendon

• Subacromial bursa

However, because the test is not specific to any one structure, it should be interpreted in combination with other examination findings².

Diagnostic Accuracy

The diagnostic utility of the neer test is variable. One study reports sensitivity as high as 0.88, suggesting that a negative result can reduce the likelihood of subacromial impingement³. However, specificity values vary significantly, and a positive test alone is not sufficient for a diagnosis.

A systematic review published in StatPearls notes that when used as part of a cluster—including the Hawkins-Kennedy and empty can tests—the diagnostic confidence improves⁴.

Limitations

• Lack of specificity: Pain may result from several shoulder conditions, including bursitis or rotator cuff tendinopathy.

• False positives: Individuals with limited shoulder flexion or capsular stiffness may experience discomfort during passive flexion regardless of impingement.

• Subjectivity: The test depends on symptom reproduction, which may vary between patients.

Example: Using the Neer Test in Practice

Patient case: A 42-year-old recreational swimmer reports shoulder pain when reaching overhead, particularly during freestyle strokes and when shampooing hair. The discomfort is localized to the anterior shoulder and has gradually increased over two months.

Evaluation steps:

• The therapist positions the patient standing and stabilizes the scapula with one hand.

• With the arm internally rotated, the therapist passively elevates the arm into flexion.

• The patient reports a sharp pain at approximately 160° of flexion, similar to their swimming-related symptoms.

Interpretation:

• The test is positive.

• Additional tests are performed, including the Hawkins-Kennedy test (also positive) and resisted shoulder abduction (painful and weak).

• Based on these findings, the therapist suspects subacromial impingement with supraspinatus involvement.

Treatment implications:

• Begin with pain-modifying techniques such as manual therapy and activity modification.

• Progress to scapular stabilization and rotator cuff strengthening once pain subsides.

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How the Neer Test Fits into a Broader Exam

The neer test is best used as part of a multi-test approach. Other assessments that can complement it include:

• Hawkins-Kennedy Test: Performed with the shoulder flexed to 90° and internally rotated; also stresses the subacromial space.

• Empty Can Test: Identifies supraspinatus weakness or irritation.

• Painful Arc Test: Assesses active abduction range with pain between 60° and 120°.

Using these tests together can improve diagnostic confidence. In practice, clinicians often apply 2–3 special tests and correlate findings with patient history, palpation, and functional movement screening⁴.

The neer test is a time-efficient and accessible way to screen for signs of subacromial impingement. While it does not pinpoint the exact source of pain, it can help reproduce familiar symptoms and inform the direction of care. By combining the neer test with other examination techniques and patient-specific information, physical therapists can make more informed decisions during both evaluation and treatment planning.

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References

1. Stanford Medicine 25 – Shoulder Examination. https://med.stanford.edu/stanfordmedicine25/the25/shoulder.html

2. Verywell Health – Neer’s Test for Shoulder Impingement. https://www.verywellhealth.com/neers-test-to-see-if-you-have-rotator-cuff-impingement-2696436

3. 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. https://journals.lww.com/jbjsjournal/abstract/2005/07000/total_knee_arthroplasty_in_juvenile_rheumatoid.13.aspx

4. StatPearls – Shoulder Impingement Syndrome. https://www.ncbi.nlm.nih.gov/books/NBK554518/