Neer Impingement Test: Shoulder Special/Orthopedic Test

Neer Impingement Test: Shoulder Special/Orthopedic Test

This is Brent of the Brookbush Institute, and in this video we’re going over the Neer Impingement Test, a special or orthopedic test used during our shoulder examination. I’m going to have my friend, Melissa, come out. She’s going to help me demonstrate. This isn’t a particularly complicated test. I’m going to take Melissa through passive shoulder flexion in the scapular plane with her humorous internally rotated, and then I’m going to add a little over-pressure to see if I can provoke symptoms. I’m going to grab Melissa just underneath the elbow with an underhanded grip. I’m going to use this hand to stabilize her scapula and thorax, because as I push up this way, I don’t want a bunch of scapular elevation. That’s not great. As I go into over-pressure, I don’t want to just push her off the table Last I checked, if you push somebody over the table, they don’t come back, and then you’re not fixing anything. We want to make sure she stays on the table and that she’s stabilized. I’m going to go ahead and turn her arm in this way, take her through all the flexion she has in the scapular plane, and then like I said, I’m going to add a little bit of over- pressure. I’ll take her just past that normal end range. Here’s the key, “Are those the symptoms you were talking about?” If those are the symptoms that she was talking about, then I have a positive Neer Test and a good indication that impingement is what is bothering Melissa. Keep in mind that if she had pain but those was not her symptoms, I need to continue doing my testing to figure out where her pain is coming from. Although she may or may not have shoulder impingement, that’s not what she came in complaining about. I need to fix what she’s complaining about first. Maybe we can address this at a later date. What’s the intent of the Neer Test? The intent of the Neer Test is to provoke symptoms in inflamed tissues. With an impingement syndrome, we’re assuming that these inflamed tissues are being caused by pinching between the humeral head and what we can call the roof of the shoulder, which is the inferior surface of the acromion and the coracoacromial ligament. Under there, we have things like your supraspinatus and infraspinatus tendon, the biceps tendon, the long head of your biceps tendon, we have your subacromial bursa, and we even have the superior portion of the capsule itself for the shoulder. All those things could be getting inflamed, because Melissa’s shoulder isn’t working right. Let’s say she has some sort of arthrokinematic dyskinesis that is causing these tissues to get compressed or rubbed more than they can handle during functional activities. Maybe she’s a volleyball player and just continually reaching overhead with poor shoulder mechanics is causing all of this stuff to get irritated. In the Neer Test, I’ve taken the greater tubercle and moved it into a position where I can smash it against the roof of the shoulder here, that subacromial space. If I get her symptoms, I should have a pretty good indicator that that’s what’s bothering her. Why is this such a commonly used test? I think this is a commonly used test, because it looks very much like the Maitland joint exams that we’ve all done- that active motion with over-pressure. “Melissa, can you raise your arm up? Good. Does that hurt? Does that hurt? No, all right. Clear. Good. Let me have you go out into abduction all the way up. Does that hurt? Good. Does that hurt? If I do this, though, does that hurt? Yes.” Maybe we’re getting a little bit more sensitivity out of the fact that we’re internally rotating the humorous and she’s doing this in the scapular plane. Maybe that’s a more provocative test. The truth of the matter is that the Neer Test isn’t a great test by itself. Why am I teaching this to you? It’s important that you know this test. This is a very commonly used test, and you’re going to see things like a positive Neer on various paperwork that heads your way. Maybe a doctor notes positive Neer Test and you need to understand what that is. What is happening now, because of research, when we talk about things like sensitivity and specificity, is we’re realizing a lot of these orthopedic tests or special tests aren’t great, so we’ll cluster them. The Neer Test is part of many of those clusters. I think part of the problem with all of our impingement tests is the fact that they’re usually okay too good on the sensitivity part, but the specificity is really bad. I think what you guys will find as you practice is that just about every dysfunction of the shoulder starts leading to some impingement syndrome signs, and that should kind of make sense to us. If you have a labral tear, your shoulder’s not going to move well. If it doesn’t move well, things are going to get rubbed and then pinched, and it’s going to start getting inflamed. Something like bashing your humeral head into the underside of your shoulder is going to hurt. We don’t have a very specific test, because if somebody has a labral tear, maybe rotator cuff tear, maybe posterior capsule impingement versus internal- it all kind of gets mashed together in these tests. How do I use these tests? I’m going to go ahead and start with her subjective examination. That’s going to help a lot. Did this come on gradually or was it acute trauma? If it’s acute trauma, impingement might not be my first hypothesis. If she has signs of upper body dysfunction in my movement assessment, like in my overhead squat assessment her arms fall forward and she has scapular elevation, and she said that this came on gradually during her subjective assessment. Okay. I’m starting to think towards impingement. So, where does Neer come in? I’m probably going to do Neer in a cluster of tests, which we’re going to go over as we break down each one of these tests individually. Most importantly, is this the test that gets me to her symptoms? If it does, this becomes a great quick test for me to do pre- post-assessment both as she’s coming in from session to session, as well as maybe I’m going to try a new intervention and I want to see if it has any affect on her shoulder. I can quickly do this test. Let’s say I have her come in, “How do you feel? Pain? Yes.” I do posterior deltoid release. “How does this feel? Any better? Yes.” Oh, good. That’s one more intervention that I know is going to be effective, or maybe it’s even something I could add to her home exercise program. That’s where tests like this become super, super helpful. The other thing you might think of, which is a little outside of the box, is as we show you different special tests, you’ll see that this one is very flexion related. If I’m missing a bunch of flexion and flexion causes her pain, I might start thinking about, “Well, what’s restricting flexion? Is there a movement impairment that I can draw from this test? The muscles that happen to restrict end range flexion are also my internal rotators. We know a lot of us sit like this, so maybe I need to look at releasing things like my subscapularis, my latissimus dorsi, my teres major, my pectoralis major, and maybe do a little stretching and lengthening of those structures to see if I can get a little extensibility back and bring everything back down to normal. Here’s one more review of what the Neer Test looks like. Grab just below the elbow, internally rotate, go through the scapular plane with over-pressure, and then ask, “Does that replicate the symptoms you were talking about?” If she says yes, then I have a positive Neer and one more indicator in a cluster of signs- this is just one clue- that we might have impingement syndrome. I hope you guys enjoyed this video. I’ll talk with you soon. you

4 Replies to “Neer Impingement Test: Shoulder Special/Orthopedic Test”

  1. thanks – like i've said previously, your videos are so valuable because they give so much context into clinical practice.

    Interesting point at the end too, people I treat with subacromial pain generally lack full shoulder flexion and as a consequence will internally rotate the humerus under load during the terminal portion of an overhead press. It's definitely not always about addressing arthrokinematic/scapular dyskinesis – which seems to be the focus in NHS physiotherapy.

  2. I like this test….this is why I don't do any Empty Can exercises cause they jam the shoulder. You seem quite knowledgeable. Are there other people on YouTube you recommend listening to for fitness advice? I have been listening to one guy called Jason Blaha who seems to know his stuff…but he does write on conspiracy forums about the Illuminati, Reptilians, and Black Magic, which does make me wonder.

  3. Nice not recommended tests, I'm looking forward to seeing a test for the shoulders that you recommend, and you really deserve a big thumbs up for your awesome videos … you are so much better than my 70 years ancient professor in Egypt lol

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