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Clin Orthop Relat Res. 2007 Jul;460:130-6.

Temporal variations in a modified Neer impingement test can confound clinical interpretation.

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  • 1University of Utah Department of Orthopaedics, Utah Bone and Joint Center, Salt Lake City, UT 84107, USA.


High variability in the time required for patients to have substantial pain relief after Neer-type subacromial impingement tests might help explain conflicting data regarding their effectiveness in guiding treatment and predicting surgical outcomes. To focus on quantifying temporal variability associated with a modified (local anesthetic and corticosteroid) impingement test, we hypothesized that substantial pain relief (greater than 75% reduction) can occur beyond the 10-minute interval many clinicians use for determining results of this test. Fourteen females and 12 males (mean age, 55.6 years) who received subacromial injections for Stage II impingement completed 10-cm visual analog scales for pain at 5, 10, 20, 30, and 40 minutes postinjection. There were 11 patients (42%) who attained at least 75% relief by 10 minutes compared with nine (35%) additional patients who subsequently attained 75% relief after 10 minutes. On average, 75% reduction in pain did not occur until after 30 minutes postinjection. Data analysis also revealed two groups: (1) rapid responders with greater than 50% pain relief by 10 minutes; and (2) delayed responders with greater than 50% pain relief after 10 minutes. Assessing pain at 10 minutes for a Neer-type impingement test can fail to accurately determine a positive test in a substantial percentage of patients.

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