Reproducibility of sub-acromial impingement tests, including a new clinical manoeuver

Abstract

BackgroundThe Neer, Hawkins, and Yocum clinical tests detect sub-acromial impingement as a pathogenic process of degenerative rotator cuff disease. Their reproducibility has been little investigated. ObjectivesWe tested the reproducibility of the Neer, Hawkins, and Yocum clinical tests for detecting this sub-acromial impingement and also an original clinical manoeuver, the countertest with elevation with lateral rotation (CELR), which is a test of sub-acromial impingement. MethodsPatients with shoulder pain due to degenerative rotator cuff disease were prospectively included. They were assessed with the Neer, Hawkins and Yocum tests as well as the CELR twice at a 1 week interval. Intra- and inter-observer reproducibility was assessed by percentage agreement and the kappa coefficient of concordance with 95% confidence intervals (CIs). Concordance was poor with kappa ≤0.4, moderate >0.4, and good >0.61. It was considered suitable for clinical use with kappa >0.4. ResultsWe included 34 patients (mean [SD] age 60 [11] years; 26 females). For intra-observer reproducibility, agreement was 80% to 88%. By the kappa coefficient, intra-observer reproducibility was poor for the Neer test and moderate for the Hawkins test (0.56 [95% CI 0;0.9]) and Yocum test (0.48 [0;0.8]) and CELR (0.6 [0.2;0.9]). For inter-observer reproducibility, agreement was 73% to 88%. By the kappa coefficient, inter-observer reproducibility was poor for the Yocum test, moderate for the Hawkins test (0.54 [0.2;0.8]) and CELR (0.58 [0.2;0.8]), and good for the Neer test (0.64 [0.2;0.9]). ConclusionThe Hawkins test and CELR had a balanced profile of reproducibility suitable for clinical practice. We underline the potential interest of CELR, an original manoeuver.