Shoulder special tests earn their value when they confirm or refute a hypothesis you already formed from the subjective history - not as a checklist run on every patient. This guide gathers the tests that actually change management, grouped by suspected pathology, with how to perform each one and how to interpret a positive or negative result.
Sensitive screening tests - most useful for ruling subacromial pain out when negative rather than confirming it when positive.
Most specific when the apprehension–relocation–surprise cluster is positive together.
There is no fixed must-do list - choose tests to confirm or refute the hypothesis your subjective examination suggested. For most painful, non-traumatic shoulders, a rotator cuff cluster (empty can, drop-arm, external rotation lag) plus Hawkins-Kennedy is a sensible starting screen.
In isolation most have only modest sensitivity and specificity. Diagnostic value rises substantially when tests are clustered for a single hypothesis and interpreted alongside the history and functional testing.
Both provoke the subacromial space. Hawkins-Kennedy uses 90° flexion with passive internal rotation; Neer uses passive overhead elevation in internal rotation. Both are sensitive but not specific, so they are most useful for ruling subacromial pain out when negative.
Mid-range pain (roughly 60–120° of active abduction) suggests subacromial pathology such as rotator cuff tendinopathy or impingement. Pain in the final 10–20° of elevation points more toward the acromioclavicular joint.