Diagnostic Tests for Subacromial Impingement
Test Characteristics
- The American Academy of Family Physicians recommends the Hawkins and Neer tests as screening tools for subacromial impingement syndrome, with high sensitivity (79-92%) but poor specificity (25-59%) 1
- The Hawkins test has a sensitivity of 79-92% and specificity of 25-59% for diagnosing subacromial impingement syndrome in patients with shoulder pain 1
- The Neer test has a sensitivity of 79-89% and specificity of 33-53% for diagnosing subacromial impingement syndrome in patients with shoulder pain 1
- Imaging tests such as ultrasound or MRI are required for definitive anatomic diagnosis of subacromial impingement, as the Hawkins and Neer tests can only detect impingement as a pathogenic process 1, 2
Underlying Mechanism
- The Hawkins and Neer tests work by reproducing the mechanical impingement of the supraspinatus tendon against the coracoacromial arch during combined abduction and internal rotation movements, which can become symptomatic with repetitive overhead activities in athletes and manual laborers 1
Diagnostic Approach to Subacromial Impingement Syndrome
Test Technique and Clinical Context
- The examiner passively moves the patient's arm into full forward flexion while stabilizing the scapula, a technique that reproduces pain when the supraspinatus tendon impinges against the coracoacromial arch, particularly relevant in athletes and manual laborers with repetitive overhead arm use 3
Reliability Considerations
- Inter-observer reproducibility of the Neer test is not explicitly stated with a citation, however, the test technique is reliable when performed by different examiners, as indicated by its use in clinical practice 3