Reverse Impingement Test or Impingement Relief Test
Purpose of Reverse Impingement Test or Impingement Relief Test:
To confirm the diagnosis of ‘impingement syndrome’ by reversing/relieving the painful arc and/or eliminating the ‘impingement sign’ after initially reproducing the patient’s shoulder pain with shoulder impingement tests such as Neer’s test (1-3).
Patient position:
Sitting upright with affected arm relaxed by the side.
Examiner position:
Standing beside/behind the patient’s affected side/arm.
Procedure:
First, the examiner must perform active shoulder impingement (shoulder abduction and flexion)
tests or functional activity (that reproduces the patient’s shoulder pain) three to five times each (1).
To perform the active impingement test, ask the patient to actively elevate (shoulder abduction or flexion) the affected arm and determine if the patient’s shoulder pain is reproduced (1).The examiner should record the range of the painful arc that occurs with each trial (1).
The examiner should also record the intensity of pain on a visual analogue scale (0 to 5) for each trial (‘0’ indicates no pain, ‘1’ indicates minimal pain, ‘3’ indicates moderate pain, and ‘5’ indicates severe/extreme pain) (1).
Next, repeat the test while applying a gentle inferior or postero-inferior glide on the humeral head, if the pain was present during shoulder abduction or flexion respectively (1).
Outcome:
The test is positive (presence of impingement) if there is a reduction in the patient’s shoulder pain (1).
Additional Notes:
The reverse impingement test for shoulder joint can be performed with the patient lying in supine position as well (3).
While the patient is in supine lying, the affected arm should be elevated in the frontal plane (abduction) and externally rotated as tolerated (3). He examiner should apply inferiorly directed force over the proximal head of humerus as the arm is abducted and externally rotated (3).
References:
- Corso G. Impingement relief test: an adjunctive procedure to traditional assessment of shoulder impingement syndrome. Journal of Orthopaedic & Sports Physical Therapy. 1995;22(5):183-92.
- Kelley MJ, Clark WA. Orthopedic Therapy of the Shoulder: Lippincott; 1995.
- Magee DJ. Orthopedic physical assessment-E-Book: Elsevier Health Sciences; 2014.