Clinical Orthopaedics and Related Research®

, Volume 469, Issue 3, pp 813–818 | Cite as

Does a Positive Neer Impingement Sign Reflect Rotator Cuff Contact with the Acromion?

  • Xiaofeng Jia
  • Jong Hun Ji
  • Vinodhkumar Pannirselvam
  • Steve A. Petersen
  • Edward G. McFarland
Clinical Research

Abstract

Background

One possible cause of shoulder pain is rotator cuff contact with the superior glenoid (cuff-glenoid contact) with the arm in flexion, as occurs during a Neer impingement sign. It has been assumed that the pain with a Neer impingement sign on physical examination of the shoulder was secondary to the rotator cuff making contact with the anterior and lateral acromion.

Questions/purposes

We determined if the arm position where pain occurs with a Neer impingement sign would correlate with the position where the rotator cuff made contact with the superior glenoid, as determined by arthroscopic evaluation.

Patients and Methods

We prospectively studied 398 consecutive patients with a positive Neer impingement sign during office examination and used a handheld goniometer to measure (in degrees of flexion) the arm position in which impingement pain occurred. During subsequent arthroscopy, the arm was moved into a similar position, and we measured the arm’s position in flexion at the point the rotator cuff made contact with the superior glenoid using a handheld goniometer. We compared the degrees of flexion at which pain occurred preoperatively and at which there was cuff-glenoid contact.

Results

Among the 398 patients, 302 (76%) had arthroscopically documented cuff-glenoid contact, whereas 96 did not. For the 302 patients with a positive Neer sign preoperatively and with arthroscopically documented cuff-glenoid contact, the average preoperative impingement pain position was 120.1° ± 26.7°, similar to that of the average intraoperative cuff-glenoid contact position of 120.6° ± 14.7°.

Conclusions

Our data suggest pain associated with a positive Neer sign more often relates to contact of the rotator cuff with the superior glenoid than to contact between the rotator cuff and acromion.

Level of Evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

References

  1. 1.
    Andrews JR, Broussard TS, Carson WG. Arthroscopy of the shoulder in the management of partial tears of the rotator cuff: a preliminary report. Arthroscopy. 1985;1:117–122.CrossRefPubMedGoogle Scholar
  2. 2.
    Andrews JR, Carson WG Jr, McLeod WD. Glenoid labrum tears related to the long head of the biceps. Am J Sports Med. 1985;13:337–341.CrossRefPubMedGoogle Scholar
  3. 3.
    Bigliani LU, Levine WN. Subacromial impingement syndrome. J Bone Joint Surg Am. 1997;79:1854–1868.PubMedGoogle Scholar
  4. 4.
    Boon AJ, Smith J. Manual scapular stabilization: its effect on shoulder rotational range of motion. Arch Phys Med Rehabil. 2000;81:978–983.CrossRefPubMedGoogle Scholar
  5. 5.
    Bovens AM, van Baak MA, Vrencken JG, Wijnen JA, Verstappen FT. Variability and reliability of joint measurements. Am J Sports Med. 1990;18:58–63.CrossRefPubMedGoogle Scholar
  6. 6.
    Chronopoulos E, Kim TK, Park HB, Ashenbrenner D, McFarland EG. Diagnostic value of physical tests for isolated chronic acromioclavicular lesions. Am J Sports Med. 2004;32:655–661.CrossRefPubMedGoogle Scholar
  7. 7.
    Davidson PA, Elattrache NS, Jobe CM, Jobe FW. Rotator cuff and posterior-superior glenoid labrum injury associated with increased glenohumeral motion: a new site of impingement. J Shoulder Elbow Surg. 1995;4:384–390.CrossRefPubMedGoogle Scholar
  8. 8.
    DeOrio JK, Cofield RH. Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. J Bone Joint Surg Am. 1984;66:563–567.PubMedGoogle Scholar
  9. 9.
    Graichen H, Bonel H, Stammberger T, Englmeier KH, Reiser M, Eckstein F. Subacromial space width changes during abduction and rotation: a 3-D MR imaging study. Surg Radiol Anat. 1999;21:59–64.PubMedGoogle Scholar
  10. 10.
    Green S, Buchbinder R, Forbes A, Bellamy N. A standardized protocol for measurement of range of movement of the shoulder using the Plurimeter-V inclinometer and assessment of its intrarater and interrater reliability. Arthritis Care Res. 1998;11:43–52.CrossRefPubMedGoogle Scholar
  11. 11.
    Hoving JL, Buchbinder R, Green S, Forbes A, Bellamy N, Brand C, Buchanan R, Hall S, Patrick M, Ryan P, Stockman A. How reliably do rheumatologists measure shoulder movement? Ann Rheum Dis. 2002;61:612–616.CrossRefPubMedGoogle Scholar
  12. 12.
    Jia X, Ji JH, Petersen SA, Freehill MT, McFarland EG. An analysis of shoulder laxity in patients undergoing shoulder surgery. J Bone Joint Surg Am. 2009;91:2144–2150.CrossRefPubMedGoogle Scholar
  13. 13.
    Jia X, Ji JH, Petersen SA, Keefer J, McFarland EG. Clinical evaluation of the shoulder shrug sign. Clin Orthop Relat Res. 2008;466:2813–2819.CrossRefPubMedGoogle Scholar
  14. 14.
    Jia X, Petersen SA, Khosravi AH, Almareddi V, Pannirselvam V, McFarland EG. Examination of the shoulder: the past, the present, and the future. J Bone Joint Surg Am. 2009;91(suppl 6):10–18.CrossRefPubMedGoogle Scholar
  15. 15.
    Jobe CM. Posterior superior glenoid impingement: expanded spectrum. Arthroscopy. 1995;11:530–536.CrossRefPubMedGoogle Scholar
  16. 16.
    Jobe CM. Superior glenoid impingement: current concepts. Clin Orthop Relat Res. 1996;330:98–107.CrossRefPubMedGoogle Scholar
  17. 17.
    Jobe FW, Giangarra CE, Kvitne RS, Glousman RE. Anterior capsulolabral reconstruction of the shoulder in athletes in overhand sports. Am J Sports Med. 1991;19:428–434.CrossRefPubMedGoogle Scholar
  18. 18.
    Kim TK, McFarland EG. Internal impingement of the shoulder in flexion. Clin Orthop Relat Res. 2004;421:112–119.CrossRefPubMedGoogle Scholar
  19. 19.
    Kim TK, Queale WS, Cosgarea AJ, McFarland EG. Clinical features of the different types of SLAP lesions: an analysis of one hundred and thirty-nine cases. J Bone Joint Surg Am. 2003;85:66–71.CrossRefPubMedGoogle Scholar
  20. 20.
    Kim TK, Rauh PB, McFarland EG. Partial tears of the subscapularis tendon found during arthroscopic procedures on the shoulder: a statistical analysis of sixty cases. Am J Sports Med. 2003;31:744–750.PubMedGoogle Scholar
  21. 21.
    MacDonald PB, Clark P, Sutherland K. An analysis of the diagnostic accuracy of the Hawkins and Neer subacromial impingement signs. J Shoulder Elbow Surg. 2000;9:299–301.CrossRefPubMedGoogle Scholar
  22. 22.
    McFarland EG. Rotator cuff disease and impingement. In: Kim TK, Park HB, El Rassi G, Gill H, Keyurapan E, eds. Examination of the Shoulder: The Complete Guide. New York, NY: Thieme; 2006:126–161.Google Scholar
  23. 23.
    McFarland EG. Shoulder range of motion. In: Kim TK, Park HB, El Rassi G, Gill H, Keyurapan E, eds. Examination of the Shoulder: The Complete Guide. New York, NY: Thieme; 2006:15–87.Google Scholar
  24. 24.
    McFarland EG, Hsu CY, Neira C, O’Neil O. Internal impingement of the shoulder: a clinical and arthroscopic analysis. J Shoulder Elbow Surg. 1999;8:458–460.CrossRefPubMedGoogle Scholar
  25. 25.
    McFarland EG, Kim TK, Savino RM. Clinical assessment of three common tests for superior labral anterior-posterior lesions. Am J Sports Med. 2002;30:810–815.PubMedGoogle Scholar
  26. 26.
    McFarland EG, Neira CA, Gutierrez MI, Cosgarea AJ, Magee M. Clinical significance of the arthroscopic drive-through sign in shoulder surgery. Arthroscopy. 2001;17:38–43.CrossRefPubMedGoogle Scholar
  27. 27.
    Neer CS 2nd. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am. 1972;54:41–50.PubMedGoogle Scholar
  28. 28.
    Neer CS 2nd. Impingement lesions. Clin Orthop Relat Res. 1983;173:70–77.PubMedGoogle Scholar
  29. 29.
    Nho SJ, Yadav H, Shindle MK, MacGillivray JD. Rotator cuff degeneration: etiology and pathogenesis. Am J Sports Med. 2008;36:987–993.CrossRefPubMedGoogle Scholar
  30. 30.
    Paley KJ, Jobe FW, Pink MM, Kvitne RS, ElAttrache NS. Arthroscopic findings in the overhand throwing athlete: evidence for posterior internal impingement of the rotator cuff. Arthroscopy. 2000;16:35–40.CrossRefPubMedGoogle Scholar
  31. 31.
    Park HB, Yokota A, Gill HS, El Rassi G, McFarland EG. Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg Am. 2005;87:1446–1455.CrossRefPubMedGoogle Scholar
  32. 32.
    Rao AG, Kim TK, Chronopoulos E, McFarland EG. Anatomical variants in the anterosuperior aspect of the glenoid labrum: a statistical analysis of seventy-three cases. J Bone Joint Surg Am. 2003;85:653–659.PubMedGoogle Scholar
  33. 33.
    Rathbun JB, Macnab I. The microvascular pattern of the rotator cuff. J Bone Joint Surg Br. 1970;52:540–553.PubMedGoogle Scholar
  34. 34.
    Riddle DL, Rothstein JM, Lamb RL. Goniometric reliability in a clinical setting: shoulder measurements. Phys Ther. 1987;67:668–673.PubMedGoogle Scholar
  35. 35.
    Struhl S. Anterior internal impingement: an arthroscopic observation. Arthroscopy. 2002;18:2–7.CrossRefPubMedGoogle Scholar
  36. 36.
    Valadie AL 3rd, Jobe CM, Pink MM, Ekman EF, Jobe FW. Anatomy of provocative tests for impingement syndrome of the shoulder. J Shoulder Elbow Surg. 2000;9:36–46.CrossRefPubMedGoogle Scholar
  37. 37.
    Walch G, Boileau P, Noel E, Donell ST. Impingement of the deep surface of the supraspinatus tendon on the posterosuperior glenoid rim: an arthroscopic study. J Shoulder Elbow Surg. 1992;1:238–245.CrossRefGoogle Scholar
  38. 38.
    Walch G, Liotard JP, Boileau P, Noel E. [Postero-superior glenoid impingement: another shoulder impingement] [in French]. Rev Chir Orthop Reparatrice Appar Mot. 1991;77:571–574.PubMedGoogle Scholar
  39. 39.
    Walker JM, Sue D, Miles-Elkousy N, Ford G, Trevelyan H. Active mobility of the extremities in older subjects. Phys Ther. 1984;64:919–923.PubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • Xiaofeng Jia
    • 1
  • Jong Hun Ji
    • 1
  • Vinodhkumar Pannirselvam
    • 1
  • Steve A. Petersen
    • 1
  • Edward G. McFarland
    • 1
    • 2
  1. 1.Division of Shoulder Surgery, Department of Orthopaedic SurgeryThe Johns Hopkins UniversityBaltimoreUSA
  2. 2.c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic SurgeryJohns Hopkins Bayview Medical CenterBaltimoreUSA

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