Painful Arc
When assessing shoulder movement, it is common in an impingement to have what is known as a painful arc.

What this means is that a portion of your shoulder movement is painful but not the full range of motion.

For example you may have no pain when your arm is by your side. You start to lift your arm, still not pain. As your hand approaches shoulder height you start to feel pain but as you continue overhead the pain stops and you are able to extend your arm overhead fully.

Sometimes the pain can be so severe that you can’t push through it to see if you have a painful arc.

Shoulder Tests
Listed below are some common Shoulder Impingement tests used by Orthopedic Surgeons and Physical Therapists.

Neer’s Test

Neer’s impingement sign is elicited when the patient’s rotator cuff tendons are pinched under the coracoacromial arch. The test is performed by placing the arm in forced flexion with the arm fully pronated. The scapula should be stabilized during the maneuver to prevent scapulothoracic motion. Pain with this maneuver is a sign of subacromial impingement.

Hawkin’s Test

The Hawkins’ test is another commonly performed assessment of impingement. It is performed by elevating the patient’s arm forward to 90 degrees while forcibly internally rotating the shoulder. Pain with this maneuver suggests subacromial impingement or rotator cuff tendonitis.

Descriptions are provided by the American Academy of Family Physicians. Click here to visit their web page

Sensitivity & Specificity.
Sensitivity & Specificity are two very important concepts that are crucial to determining the usefulness of diagnostic tests.

Sensitivity refers to how accurate the test is at predicting a positive result, i.e. if one of these tests is positive how confident can one be that shoulder impingement is the problem.

Specificity refers to how accurate is the test in predicting a negative result, i.e. if one of these test is negative how accurately can we predict that impingement is not the cause of your shoulder pain.

Both the Neers and Hawkins tests have high sensitivity, Neers 85% & Hawkins 88%, but low sensitivity. This means that if you are positive for these tests there is a high chance that you have a shoulder impingement. If you test negative, you may still need further assessment to rule out impingement.

The painful arc test is the opposite; it has lower sensitivity but higher specificity (80.5%). This means that if you have a painful arc in your shoulder movement, further tests are needed to confirm you have shoulder impingement e.g. Neers & Hawkins. But if you don’t have a painful arc it is much less likely that your pain is due to an Impingement problem.

As a side note if you would like more information about shoulder physical therapy diagnostic tests for a labrum tear please click here to read some excellent posts by Physical Therapist Mike Reinolds.