Neer maneuver associated with a countertest in lateral rotation: a predictive test of response to dynamic humeral centering
Dr Clémence LEFÈVREa, Dr Sandra LASBLEIZa, Dr Nathaly QUINTEROa, Prof Alain YELNIKb, Prof Thomas BARDINa, Prof Philippe ORCELa, Dr Johann BEAUDREUILc
a Service de Rhumatologie, Hôpital Lariboisière-Fernand Widal, b Service de Médecine Physique et de Réadaptation, Hôpital Lariboisière-Fernand Widal, c Service de Rhumatologie et Service de Médecine Physique et de Réadaptation, Hôpital Lariboisière-Fernand Widal
Objective. Dynamic humeral centerering (DHC) is a physiotherapy modality that aims at preventing subacromial impingement. Clinical tests of subacromial impingement may be predictive of response to DHC in degenerative rotator cuff disorders (DRCD). The objective of the study was to assess the predictive value of Neer test and a countertest by passive antero-lateral elevation, the arm in lateral rotation (LR), with response to DHC as reference.
Patients and Method. Patients suffering from DRCD were prospectively included. Neer and RL tests were performed before RHD. Neer test was positive if painful (Neer +). LR maneuver was positive if the pain disappeared during passive antero-lateral elevation with the arm in lateral rotation (RL+). RHD was performed in ambulatory setting for 2 months. Response to RHD was expressed as percentage of variation and responder meaning variation > 20%, using SPADI and Constant scores.
Results. 53 patients were included: age 59±11 yr, ratio F/M 37/16, pain duration 27±55 mo. Baseline clinical profiles were as follows: 36 patients Neer +, 17 Neer -, 20 LR +, 33 LR -. Neer test was not associated with outcomes after DHC. Conversely, LR+ patients had higher improvement than LR- patients (SPADI 43% vs -15, p=0,02 ; Constant 37 vs 10, p=0,01). LR+ patients were more frequently responders to RHD (SPADI 67% vs 28, OR 5,1 [IC95 1,5-17,8], p=0,01 ; Constant 63 vs 30, OR 3,9 [1,2-13], p=0,02). Baseline LR maneuver categorized responders and non-responders with following accuracy : 70% [IC95 57-83] for SPADI score and 67% [54-80] for Constant score.
Discussion. This study demonstrates variability of response to DHC according to simple baseline clinical profiles. LR+ patients showed better response to DHC. LR maneuver may be a predictive test of response to RHD. It could be useful in therapeutic decision making in DRCD.
Keywords : Dynamic humeral centering, subacromial impingement, rotator cuff disorders, test of subacromial impingement, prognosis