Accuracy of physical examination in subacromial impingement syndrome

In this study of 55 patients, the authors studied five findings and concluded, “The cut point of 3 or more positive of 5 tests can confirm the diagnosis…, while less than 3 positive of 5 rules out.” If you look at the accuracies and the predictive values below, I think you will agree these results are overstated and not very helpful clinically. The shoulder is still very hard to examine.
Diagnostic Accuracy for Impingement Shoulder Tests among 55 patients with a prevalence of impingement of 29%
Finding Sensitivity (%) Specificity (%) Kappa Positive predictive value Negative predictive value
Hawkins-Kennedy 63 62 39 40 61
Neer 81 54 40 42 13
Painful arc 75 67 45 48 13
Empty can (Jobe) 50 87 47 61 19
External rotation resistance 56 87 67 64 17
3 or more of 5 findings positive 75 74 54 12

How to do the tests

YouTube videos demonstrating the tests

This has been added to


Michener LA, Walsworth MK, Doukas WC, & Murphy KP (2009). Reliability and diagnostic accuracy of 5 physical examination tests and combination of tests for subacromial impingement. Archives of physical medicine and rehabilitation, 90 (11), 1898-903 PMID: 19887215


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