Subacromial Impingement Cluster

Original Editor - Stacy Callow

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Purpose[edit | edit source]

To test for the presence of subacromial impingement

Tests for Subacromial Impingement[1][2][edit | edit source]

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 canSN:  .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.

Clusters[edit | edit source]

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)[1]

If Painful arc sign, Drop-arm sign, Infraspinatus muscle test positive the +LR:  15.57 of full thickness rotator cuff tear[2] 

If Hawkins-Kennedy impingement sign, Painful arc sign, Infraspinatus muscle test positive then +LR:  10.56 of some type of impingement present[2]

Painful arc, empty can and external rotation resistance are the (2 or more tests are positive) best combination for the diagnosis of Subacromial Impingement Syndrome.[3]

Painful arc and external rotation resistance are the (both tests are negative) best combination for ruling out Subacromial Impingement Syndrome.[3]

References[edit | edit source]

  1. 1.0 1.1 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.
  2. 2.0 2.1 2.2 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.
  3. 3.0 3.1 Chen CW, Pan ZE, Zhang C, Liu CL, Chen L. Zhongguo Gu Shang. 2016;29(5):434-438.