To determine the efficacy of Neer’s test in the diagnosis of subacromial impingement of the shoulder

Abstract

Introduction: Subacromial impingement syndrome (SIS) is a clinical syndrome most often attributed to patients presenting with shoulder pain1 and encompasses a spectrum of subacromial pathologies ranging from bursitis, rotator cuff tendinosis, and partial tears leading up to full-thickness tear of the rotator cuff.. Several tests or maneuvers, like the Neer’s test, are used in daily clinical practice to demonstrate the presence of SIS and to localize the periarticular lesions, but their accuracy is still questioned. Here we seek to determine the efficacy of Neer’s test by comparing the clinical findings with that of MRI findings. Materials and Methods: The study was performed on 100 shoulders over a period of 2 years at a tertiary care hospital. In patients who satisfied the inclusion criteria, a working diagnosis of Shoulder Impingement Syndrome was made by performing classical tests like Hawkin’s and Neer’s Sign which was followed by a Neer’s test. MRI was then performed on each of the shoulders after 7 days to avoid fluid signals post injection and the findings were noted after the MRI was evaluated by a radiologist. Diagnostic efficacy of the Neer’s test was then determined by 2x2 table for calculating the specificity, sensitivity, positive predictive value, negative predictive value and diagnostic accuracy using the “openepi’’ software with confidence interval being kept at 95%.Results and Conclusion: Neer’s test is a sensitive test for diagnosis of SIS, especially for diagnosis of partial rotator cuff tears and with a higher specificity for diagnosing rotator cuff pathology than bursitis. A negative test is especially useful in ruling out presence of partial or total rotator cuff tears with a positive test encouraging the examiner towards the diagnosis of SIS.