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Neutral Abduction Test for Managing Subacromial Impingement Syndrome

1 March 2007


Subacromial impingement is a clinical syndrome where the participant experiences pain around the tip of the shoulder that is commonly aggravated by overhead activities such as reaching or throwing. In the principal investigator's experience, a common clinical finding in patients with subacromial impingement syndrome is a restriction in a particular type of abduction. Classic abduction involves movement of the humerus in the scapular plane with concomitant external rotation. The particular pattern of abduction restriction in patients with subacromial impingement observed by the principal investigator entails passive movement of the humerus in true coronal plane abduction to 90' while maintaining the shoulder in 0' rotation throughout the movement. This specific movement pattern is referred to by the principal investigator as "neutral abduction", and a clinical test being proposed to assess this movement is termed the "neutral abduction test". The results of this study showed that the "neutral abduction test" may be helpful as a clinical tool to quantify physical impairment in symptomatic shoulders of patients with subacromial impingement syndrome. This clinical test can be performed reliably by the same examiner (ICC [3,3] = 0.97, SEM = 1.22'), and the smallest detectable difference with this measurement procedure is 4'. Additionally, this "neutral abduction test" differentiated symptomatic from asymptomatic shoulders in patients with an irnpingement diagnosis, and exhibited changes after physical therapy intervention that corresponded to improvement in self-reported disability as measured by the Shoulder Pain and Disability Index (SPADI) (Pearson r = - .80). Future studies with larger samples are necessary to substantiate these preliminary findings. If these findings are replicated, the "neutral abduction test" should be considered as an impairment-based outcome tool in studies exploring treatment outcomes in patients with subacromial pathology.


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