Execution
- 1Position the patient standing and observe the shoulder from anterior and posterior views.
- 2Ask the patient to actively elevate the arm through abduction or scaption to full available range.
- 3Ask the patient to lower the arm through the same arc.
- 4Record the angle range where pain begins and end.
- 5Differentiate mid-range subacromial pain from end-range acromioclavicular pain by location and angle.
Positive outcome
Pain during the mid-range of elevation, classically about 60° to 120°, is positive for subacromial / rotator cuff-related pain. Magee also describes pain in the last 10° to 20° of elevation, around 170° to 180°, as more suggestive of acromioclavicular joint pathology or an end-range impingement response. Anterior shoulder pain is more typical for SAPS than pain localised directly over the AC joint.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Michener et al. (2009) | NA | 75 | 67 | 2.25 | 0.38 |
| Park et al. (2005) | NA | 73.5 | 81.1 | 3.98 | 0.33 |
| Hegedus et al. (2012) | NA | 53 | 76 | 2.30 | 0.62 |
CommentPainful arc has better clinical value than Hawkins or Neer as a standalone SAPS sign because specificity is usually higher. Angle and pain location matter: mid-range anterior / lateral pain fits SAPS better than a terminal arc localised to the AC joint. Magee also notes that the arc may occur in forward flexion or scaption, but abduction is usually the clearest movement.
Moderate Clinical Value