Sports Medicine Research: In the Lab & In the Field: It May be Time to Update Your Neer Test (Sports Med Res)


Monday, July 24, 2017

It May be Time to Update Your Neer Test

The diagnostic value of a modified Neer test in identifying subacromial impingement syndrome.

Goushen Y, Chongxi R, Guoqing C, Junling X, and Hailong J. Eur J Orthop Surg Traumatol. 2017. [Epub Ahead of Print].

Take Home Message: A modified Neer test may be beneficial at differentiating between subacromial impingement syndrome and frozen shoulder.

Subacromial impingement syndrome is a common shoulder injury in both athletes and non-athletes. While the Neer test is the most common special test for diagnosing subacromial impingement syndrome, it is also positive in patients with frozen shoulder. Therefore, Goushen and colleagues completed a single-center, prospective study to evaluate the diagnostic accuracy of a modified Neer test in diagnosing subacromial impingement syndrome and ruling out frozen shoulder. The authors included 82 consecutive outpatients (50 males, 85 shoulders, 15 to 65 years of age) complaining of symptoms relating to shoulder disease. Following x-ray, magnetic resonance imaging, and clinical exam, a clinician confirmed the diagnosis based on established diagnostic criteria. The most common diagnoses were ~47% of shoulders with subacromial impingement syndrome, 15 shoulders with frozen shoulder, 13 shoulders had reoccurring dislocations and 9 had labrum injuries and rotator cuff tears. Clinicians also performed both the modified and classical Neer test on all patients. The modified Neer test differs from the classical Neer test as the patient’s affected arm is abducted to 90 degrees in the scapular plane with the palm down and then will be externally rotated to 90 degrees with the onset of symptoms being a positive test. Overall, the specificity and sensitivity of the modified Neer test for impingement syndrome was 96% and 85% respectively (overall accuracy = 91%). This was an improvement compared to the classical Neer test, which had a sensitivity and specificity of 90% and 50% respectively (accuracy = 69%). The classical Neer test was incorrectly positive when patients had frozen shoulder. In contrast, the modified Neer test correctly tested negative for these patients.

Overall, the authors introduce a modified version of the Neer test that may be useful, especially when the patient may have frozen shoulder. The results of this study suggest that the modified Neer test is a more accurate test compared to the classical Neer test. This modified test was not only accurate in its diagnosis of subacromial impingement syndrome but it also accurately ruled out frozen shoulder. For example, 34 out of 36 shoulders with a positive modified test had impingement syndrome and the test only missed 6 cases of impingement syndrome. In contrast, the classical Neer test missed classified 22 shoulders with impingement and missed 4 cases of impingement. It’s important to note that it is unclear whether the assessor was blinded to the diagnosis. While this is likely, it would be beneficial to see these findings replicated by an independent group in another sample of patients. The clinical usefulness of these results may depend on your patient population. While all clinicians should strive to use the most accurate tests, clinicians who see patients at high risk for frozen shoulder, will find this test more useful than those clinicians who rarely see these patients. Ultimately, the modified Neer test may be a new, valuable tool in the clinician’s arsenal for evaluating shoulder pathology. Until more research can verify these results, clinicians should consider using both tests to get the best overall impression of their patient’s injury and to determine which test they think is performing best in their clinic with their patients.

Questions for Discussion: What setting are you currently in and within that setting, do you encounter many patients with frozen shoulder. If so, would you consider using the modified Neer test in future evaluations?

Written by: Kyle Harris
Reviewed by: Jeffrey Driban

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