Neer’s test is a physical exam maneuver used to check for shoulder impingement, a condition where soft tissues in your shoulder get pinched between bones during overhead movement. It takes about 30 seconds, involves no equipment, and is one of the most commonly performed shoulder tests in orthopedic and primary care offices. The test is named after Dr. Charles Neer II, an orthopedic surgeon who reshaped the understanding of shoulder impingement and rotator cuff problems starting with his landmark work in 1972.
What Happens During the Test
You’ll stand with your arms relaxed at your sides. Your provider will stand next to you and place one hand on top of your affected shoulder, pressing gently to hold your shoulder blade in place. With their other hand, they’ll rotate your arm so your thumb points toward the floor and your palm faces outward, away from your body.
From that position, your provider slowly lifts your arm straight up in front of you. You stay relaxed and let them do the lifting, which is why it’s considered a “passive” range of motion test. The whole thing takes just a few seconds per arm.
What the Test Is Checking For
As your arm rises with the thumb pointed down, the bony knob near the top of your upper arm bone (the greater tuberosity) gets pushed toward the bony roof of your shoulder (the acromion) and the tough ligament that connects it to another bony projection in front. This narrows the small space where your rotator cuff tendons and a fluid-filled cushion called the bursa sit. If those structures are inflamed, swollen, or torn, compressing them this way reproduces your pain.
Research using direct observation has shown that during the Neer maneuver, the structure most likely being compressed on the rotator cuff side is the supraspinatus tendon, the tendon that runs along the top of the shoulder joint and is the most commonly injured part of the rotator cuff.
What a Positive Result Means
The test is considered positive if you feel a sharp or familiar pain in the front or top of your shoulder as your arm is lifted. The key detail is that the pain should match the symptoms you’ve been experiencing, not just general discomfort from having your arm moved by someone else. A positive Neer’s test suggests one of several overlapping shoulder problems:
- Subacromial bursitis: inflammation of the cushioning sac beneath the acromion
- Rotator cuff tendinitis: irritation or swelling of the tendons that stabilize your shoulder
- Rotator cuff tear: a partial or complete tear in one of those tendons
The test can’t distinguish between these conditions on its own. It tells your provider that something in that narrow subacromial space is irritated, but imaging (usually an MRI or ultrasound) is needed to identify exactly what’s going on.
How Accurate the Test Is
Neer’s test is better at catching problems than ruling them out. Its sensitivity, the ability to correctly identify people who do have a shoulder issue, is about 75% for bursitis and 85% for rotator cuff tears. That means it picks up most cases but will miss some.
The bigger limitation is specificity, the ability to correctly identify people who don’t have a problem. Specificity for bursitis sits around 47.5%, which means roughly half the people without bursitis will still test positive. The positive predictive value (the chance that a positive result actually reflects disease) is similarly low, around 36% for bursitis. In practical terms, a positive Neer’s test raises suspicion but doesn’t confirm a diagnosis by itself. That’s why providers rarely rely on a single test.
Neer’s Sign vs. Neer’s Impingement Test
You may see these two terms used interchangeably, but they’re technically different. The “Neer sign” is the pain response during the passive arm raise described above. The “Neer impingement test” adds a second step: a numbing injection into the subacromial space. If the injection reduces your pain by at least 50% and the maneuver no longer hurts, that’s a positive impingement test. The logic is straightforward. If numbing the space eliminates the pain, the pain was coming from that space rather than from somewhere else, like the joint itself.
In everyday clinical settings, most providers perform the Neer sign (the arm raise alone) and combine it with other physical tests rather than doing the injection version.
How It Compares to the Hawkins-Kennedy Test
The Hawkins-Kennedy test is the other major impingement test, and your provider will often do both in the same visit. Instead of lifting your arm overhead, the Hawkins-Kennedy test involves raising your arm to 90 degrees in front of you and then rotating it inward. This compresses slightly different structures.
On the rotator cuff side, the Neer maneuver primarily compresses the supraspinatus tendon (the top of the cuff), while the Hawkins-Kennedy test targets the subscapularis tendon (the front of the cuff). For detecting bursitis, the Hawkins-Kennedy test is more sensitive at 92% compared to 75% for the Neer test. For rotator cuff tears, they’re closer: 88% versus 85%. Both tests share the same weakness of low specificity, so neither is great at ruling out problems on its own. Used together, they give your provider a much clearer picture than either test alone.
What Happens After a Positive Test
A positive Neer’s test is a starting point, not a final answer. Your provider will typically combine it with other hands-on tests, like the Hawkins-Kennedy, the empty can test, and strength testing of your rotator cuff muscles. If the clinical picture points toward impingement or a rotator cuff problem, the next step is usually imaging. An MRI can show whether you’re dealing with inflammation, a partial tear, or a full-thickness tear, and that distinction matters because it shapes the treatment plan.
For most people, a positive Neer’s test leads to conservative treatment first: physical therapy focused on strengthening the rotator cuff and the muscles around your shoulder blade, activity modification to reduce overhead repetition, and anti-inflammatory measures. Surgery only enters the conversation if symptoms persist after several months of consistent rehab or if imaging reveals a large or complete tear.