Neer Impingement Test

The Neer Impingement Test is an orthopedic examination technique used to identify subacromial impingement—mechanical compression of the rotator cuff tendons (especially supraspinatus), biceps long head tendon, and/or subacromial bursa—between the humeral head and the acromion/coracoacromial arch. This test is especially relevant in clients with shoulder pain during overhead motion or following repetitive use.

How the Test is Performed

• Client is seated or standing, with arms relaxed at the side.

• The examiner stands to the tested side and stabilizes the scapula with one hand to prevent it from rotating upward.

• With the other hand, the examiner internally rotates the arm (thumb pointing downward) and passively flexes the shoulder forward through a full range (raising the arm upward in the sagittal plane and over the head).

• A positive sign is indicated by pain reproduced in the anterior or lateral aspect of the shoulder during this maneuver—particularly at or near end-range elevation or between 60–120 degrees of flexion.

• Pain location may help distinguish:

  • Anterior pain: More indicative of subacromial impingement

  • Posterior pain: More suggestive of internal impingement

Clinical Significance

• The test stresses the subacromial space, compressing soft tissues between the humeral head and anterior acromion, and is most often positive when there is rotator cuff pathology (especially supraspinatus), subacromial bursitis, or biceps tenosynovitis.

• The Neer Test should be interpreted as part of a cluster with other impingement tests (Hawkins-Kennedy, Empty Can) for higher diagnostic accuracy.

• While the Neer Test is sensitive for detecting impingement (negative test helps rule out), it is not highly specific—pain can result from various non-impingement sources.

Assessment

• Use the Neer Test for clients with shoulder pain, reduced overhead motion, or suspected impingement.

• Record the presence, location, and quality of pain, and correlate findings with palpation, movement analysis, and client history.

• Integrate with other orthopedic tests to support clinical reasoning and track functional changes over time.

Treatment

• For a positive Neer Test, avoid aggressive overhead stretching or deep pressure directly into the subacromial space or rotator cuff tendon insertions.

• Focus on gentle soft tissue work, scapular stabilization techniques, and postural correction to reduce mechanical stress on the impinged tissues.

• Educate clients to avoid provocative patterns (repeated overhead lifting, sleeping with arm overhead) and implement pain-modifying practices.

• Refer clients for further medical or physiotherapy assessment if there is marked weakness, persistent pain, or substantial functional limitation.

Safety and Referral

• Do not perform repetitive impingement maneuvers or aggressive mobilizations if there is evidence of severe rotator cuff tear, acute bursitis, or unrelenting pain—refer as needed.

• Modify or defer massage in the presence of acute inflammatory signs, traumatic injury, or significant loss of range of motion.