Anatomy of provocative tests for impingement syndrome of the shoulder

The purpose of this study was to describe the extra- and intra-articular an atomic relationships present during the Neer and Hawkins tests. Nine fresh- frozen cadaveric shoulders were positioned in the impingement position desc ribed by Neer (n = 5) or that described by Hawkins (n = 4), embedded in pol yurethane, and studied with the use of a cross-sectional technique. All sho ulders placed in the Neer position demonstrated soft tissue contact with th e medial acromion and contact between the articular surface of the rotator cuff tendons and the anterosuperior glenoid rim. Shoulders placed in the Ha wkins position demonstrated consistent contact between soft tissues and the coracoacromial ligament. In all Hawkins positioned shoulders, contact betw een the articular surface of the rotator cuff tendons and the anterosuperio r glenoid was observed. The subscapularis tendon was deformed by the coraco id in I of the Hawkins positioned specimens. Although factors inherent to h uman subjects such as edema and muscle tone may influence the anatomy, thes e provocative tests for subacromial impinge ment appear to elicit contact c onsistent with impingement.