Painful Arc Sign | Subacromial Pain Syndrome Assessment

The Painful Arc Test is considered a hallmark sign of patients with subacromial pain syndrome. In fact, a general classification for patients in shoulder pain is to divide them into 1) patients with a painful abduction trajectory, 2) patients with instability and 3) patients with a marked reduction in active and passive range of motion.
Hedgedus et al. (2012) reviewed the literature on which physical examination tests provide clinicians with the most value when examining the shoulder. Their review revealed a sensitivity of 53%and specificity of 76%. It’s thus neither very sensitive nor specific in the diagnosis of subacromial pain syndrome, which is why we give it a weak clinical value as a stand-alone test.

To examine for the painful arc Sign instruct the patient to slowly abduct the arms with the thumbs pointing upwards. The Painful Arc is characterized by a painful trajectory usually between 60°-120° of abduction with less pain at the beginning and end ranges of motion pain. At 170°-180° of abduction is seen in patients with shoulder complaints due to AC joint pathology.

Other common orthopedic tests for subacromial pain syndrome (SAPS) are:

Neer Test

Hawkins-Kennedy Test

Empty Can Test

Full Can Test

Cluster of Michener

Hegedus EJ, Goode AP, Cook CE, Michener L, Myer CA, Myer DM, Wright AA. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. British journal of sports medicine. 2012 Nov 1;46(14):964-78.