Painful Arc

Original Editor - Tyler Shultz

Top Contributors - Tyler Shultz, Shaimaa Eldib, Rachael Lowe, Kim Jackson and Kai A. Sigel


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This test is commonly used to identify possible subacromial impingement syndrome. As with most special tests, a positive result on performance of the painful arc is not a definitive indicator of a subacromial impingement.[1]


With the patient in either sitting or standing the patient should be instructed to abduct the arm in the scapular plane. While abducting the arm, if the patient experiences any pain in and around the glenohumeral joint the patient must tell the physiotherapist what they are experiencing. Once there is an onset of pain the physiotherapist will instruct the patient to continue abducting the arm as high as they can. One the patient gets to approximately 120 degrees of abduction there should be a reduction in the amount of pain being experienced. Following completion of the abduction movement the patient should then slowly reverse the motion, bring the arm back to neutral position via the movement of adduction. This test is considered to be positive if the patient experiences pain between 60 and 120 degrees of abduction which reduces once past 120 degrees of abduction. [2]


Diagnostic Test Properties for Painful Arc Sign [3][4]
Sensitivity   0.33
Specificity   0.81
Positive Likelihood Ratio   1.70
Negative Likelihood Ratio  0.84

Test Item Cluster

When this test is combined as a cluster with the Hawkins-Kennedy Impingement Sign and the Infraspinatus test, and all three tests report a positive, then the positive likelihood ratio is 10.56 and if all three tests are negative, the negative likelihood ratio is 0.17. If two of the three tests are positive, then the positive likelihood ratio is 5.03.[5]

See test diagnostics page for explanation of statistics.


  1. Cyriax J. Textbook of orthopaedic medicine: Volume one diagnosis of soft tissue lesions 8 th ed. London: Bailliere Tindall. 1984:59-60.
  2. Flynn, T.W., Cleland, J.A., & Whitman, J.M. (2008). User's guide to the musculoskeletal examination: Fundamentals for the evidence-based clinician. Buckner, Kentucky: Evidence in Motion
  3. Calis, M., Akgun, K., Birtane, M., et al. (2000). Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. Ann Rheum Dis, 59, 44-47.
  4. Çalış M, Akgün K, Birtane M, Karacan I, Çalış H, Tüzün F. Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. Annals of the rheumatic diseases. 2000 Jan 1;59(1):44-7.
  5. Park, H.B., Yokota, A., Gill, H.S., EI RG, McFarland, E.G. (2005). Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg Am, 87(7), 1446-1455.