Shoulder Orthopaedic Test: Neers Test

Neer's test is a physical examination maneuver used to identify possible subacromial impingement syndrome. It is performed by the examiner passively elevating the patient's arm in forward flexion, with the patient's elbow extended and the palm facing down. This maneuver brings the greater tuberosity of the humerus in contact with the undersurface of the acromion and the coracoacromial ligament, potentially causing impingement of the supraspinatus tendon and the subacromial bursa.

Procedure:

1. The patient stands or sits with their arm at their side.
2. The examiner stabilizes the scapula with one hand while elevating the patient's arm in forward flexion with the other hand. The arm should be raised to the point where the patient experiences discomfort or pain.
3. The examiner may also perform the test with the arm in internal rotation to assess for impingement of the subscapularis tendon. To do this, the examiner holds the patient's wrist and rotates the arm inward until resistance is felt.
4. The test is considered positive if the patient experiences pain or discomfort during elevation of the arm or with internal rotation.

If pain is elicited during the test, it is considered a positive result and may indicate subacromial impingement syndrome. 

References:

1. Neer, C. S., Craig, E. V., Fukuda, H. (1983). Cuff-tear arthropathy. The Journal of Bone and Joint Surgery, 65(9), 1232-1244.
2. Hegedus, E. J., Goode, A. P., Cook, C. E., Michener, L., Myer, C. A., Myer, D. M., Wright, A. A. (2012). Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. British Journal of Sports Medicine, 46(14), 964-978.
3. Michener, L. A., McClure, P. W., Karduna, A. R. (2006). Anatomical and biomechanical mechanisms of subacromial impingement syndrome. Clinical Biomechanics, 21(8), 847-858.