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The neer sign and hawkins-kennedy test for shoulder impingement

The Neer sign and Hawkins-Kennedy test for shoulder
Two clinical diagnostic tests that take little time to undertake pathoanatomy of this clinical test involved driving the and are commonly performed by primary practitioners greater tuberosity under the coracoacromial ligament dealing with shoulder subacromial impingement are the (Hawkins and Kennedy 1980). Hawkins and Kennedy Neer sign (Neer 1983) and Hawkins-Kennedy test (Hawkins (1980) noted that their impingement test was less reliable Requirements for testing: The Neer sign constitutes the first
Diagnostic accuracy: The Hawkins-Kennedy test has
part of the Neer injection impingement test where one hand derived negative likelihood ratios between 0.00 and 0.88 stabilises the patient’s scapula while the other hand raises and positive likelihood ratios between 1.14 and 2.12 in seven the arm into full flexion (Neer 1983). This was thought to evaluations across three studies (Hughes et al 2008). The cause the greater tuberosity to impinge against the anterior Neer sign has derived negative likelihood ratios between acromion, damaging the rotator cuff tendons, long head 0.31 and 0.93 and positive likelihood ratios between 1.03 of biceps, and the subacromial bursa, with a positive test and 2.31 in seven evaluations across three studies (Hughes indicated by pain (Neer 1983). The second part of the test involved a subsequent xylocaine injection to reduce the pain and thereby differentiate impingement lesions from other Two studies investigated the combination of the Hawkins- causes of shoulder pain (Neer 1983).
Kennedy test or the Neer sign for subacromial impingement (Hughes et al 2008). These studies derived negative The Hawkins-Kennedy test involves flexing the shoulder likelihood ratios to this combination of clinical tests between to 90° then forcibly internally rotating it (Hawkins and 0.16 to 0.95 and positive likelihood ratios between 1.04 and Kennedy 1980), although gentle internal rotation has 2.81. One study investigated the Hawkins-Kennedy test and also been suggested (Park et al 2005). A positive sign the Neer sign in combination to derive negative likelihood involves reproducing the pain of impingement (Hawkins ratios between 0.12 and 0.75 and positive likelihood ratios and Kennedy 1980). It was originally suggested that the between 1.35 and 2.63 (Ardic et al 2006).
Recent evidence suggests the pathaetiology of shoulder A recent cadaver study has highlighted that the Hawkins- impingement involves a pre-existing dysfunctional rotator Kennedy test is less likely to involve the greater tuberosity cuff causing superior humeral head migration in shoulder and causes most compression anterior to the supraspinatus elevation that causes damage to the subacromial structures tendon at the rotator interval, while the Neer sign might involve supraspinatus with internal rotation but might involve subscapularis with external rotation (Hughes et The higher the positive likelihood ratio the more probable al 2011). This study suggested that the position that most it is that a positive test will indicate the presence of the compressed the supraspinatus tendon was internal rotation condition. Positive likelihood ratios of 2–5 yield small increases in the post-test probability of condition, 5–10 moderate increases, and above 10 large increases (Grimes These shoulder impingement tests take little time and are and Shulz 2005). The smaller positive likelihood values easy to perform; however, if they do not inform clinical indicate that positive tests results are less likely to indicate reasoning, that is they are not useful in diagnosing impingement. For negative likelihood values, a lower impingement, then their continued use must be questioned. likelihood ratio indicates greater probability of a negative Future research needs to seek a valid anatomical basis for test excluding the condition and 0.2–0.5 is considered a small increase in the post-test probability of the condition, Phillip Hughes
0.1–0.2 moderate, and below 0.1 a large increase (Grimes and Shulz 2005). The larger negative likelihood ratios indicated poor diagnostic accuracy.
Poor reliability may be a factor for lack of diagnostic Ardic F et al (2006) Am J Phys Med and Rehab 85: 53.
accuracy of clinical tests. Reliability studies for these tests Calis M et al (2000) Ann Rheum Dis 59: 44.
have demonstrated around 70% agreement between testers Green R et al (2008) Phys Ther Rev 13: 17.
(Michener et al 2009) and above 98% in another study (Calis et al 2000). This disparity is surprising given the test Grimes D, Shulz K (2005) Lancet 365: 1500.
outcome is determined by the presence or absence of pain.
Hawkins R, Kennedy J (1980) Am J Sports Med 8: 151.
Hughes P et al (2008) Aust J Physiother 54: 159.
Studies investigating the diagnostic accuracy of impingement tests may have returned poor results because Hughes P et al (2011) J Sci Med Sport Ze_0'&$'&',%`$ of a lack of anatomical validity of the tests. A systematic review of the anatomical basis of clinical tests for the Lewis J (2010) Br J Sports Med 44: 918.
shoulder found that there was a lack of evidence supporting Michener L (2009) Arch Phys Med Rehab 90: 1898.
the anatomical validity of impingement testing (Green et Neer C 1983 Clin Orthop Rel Res 173: 70.
Park H et al (2005) J Bone Joint Surg (Am) 87: 1446.
Journal of Physiotherapy 2011 Vol. 57 – Australian Physiotherapy Association 2011


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