Subacromial Impingement Cluster
Original Editor - Stacy Callow
To test for the presence of subacromial impingement
Hawkins-Kennedy: Sensitivity (SN): .63 (.39–.86) Specificity(SP): .62 (.46–.77), Likelihood ratio(+LR): 1.63 (.94–2.81)
- Testing: Shoulder is flexed to 90 degrees and then internally rotated with elbow flexed to 90 degrees.
- Positive Test: Pain with IR.
Neer: SN: .81 (.62–1.0) SP: .54 (.38–.69) +LR: 1.76 (1.17–2.66)
- Testing: Examiner stablizers scapula and flexes shoulder until pain is felt or end of ROM.
- Positive Test: Pain with flexion
Painful arc: SN: .75 (.54–.96) SP: .67 (.52–.81) +LR: 2.25 (1.33–3.81)
- Testing: Shoulder is elevated in scapular plane abduction to full elevation and then lowered in same motion.
- Positive Test: Pain or pain from 60 to 120 degrees scapular plane abduction
Empty can: SN: .50 (.26–.75) SP: .87 (.77–.98) +LR: 3.90 (1.50–10.12)
- Testing: Shoulder abducted to 90 degrees and slightly adducted. Shoulder internally rotated and downward force applied.
- Positive Test: Pain or inability to maintain abduction.
External rotation resistance: SN: .56 (.32–.81) SP: .87 (.77–.98) +LR: 4.39 (1.74–11.07) .50
- Testing: Elbow flexed to 90 degrees and adducted to trunk with neutral rotation. Medially directed force applied.
- Positive Test: Pain or weakness
Cross-body adduction test: SN: .23 SP: .82
- Testing: Shoulder is elevated to 90 degrees and adducted across body.
- Positive Test: Pain with adduction
Drop arm sign: SN: .27 SP: .88
- Testing: Shoulder is elevated to full flexion and asked to slowly lower.
- Positive Test: Severe pain or inability to slowly lower.
If three of the following test are positive: Hawkins-Kennedy, neer, painful arc, empty can, and external rotation resistance then SN: .75 (.54–.96) SP: .74 (.61–.88) +LR: 2.93 (1.60–5.36) -LR: .34 (.14–.80)
If Painful arc sign, Drop-arm sign, Infraspinatus muscle test positive the +LR: 15.57 of full thickness rotator cuff tear
If Hawkins-Kennedy impingement sign, Painful arc sign, Infraspinatus muscle test positive then +LR: 10.56 of some type of impingement present
- Michener LA, Walsworth MK, Doukas WC, Murphy KP. Reliability and diagnostic accuracy of 5 physical examination tests and combination of tests for subacromial impingement. Arch Phys Med Rehabil. 2009 Nov;90(11):1898-903.
- Park HB, Yokota A, Gill HS, El Rassi G, McFarland EG. Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg Am. 2005 Jul;87(7):1446-55.
- Chen CW, Pan ZE, Zhang C, Liu CL, Chen L. Zhongguo Gu Shang. 2016;29(5):434-438.