There is more and more emerging evidence illustrating the lack of specificity and sensitivity of traditional orthopedic tests. Lewis et al (2007) demonstrated special orthopedic procedures like the Neer, Hawkin’s, full/empty can tests present with 8-9 equally active muscles when examined with indwelling electrodes. Hence, questioning their validity. ALL shoulder tissue contains nociceptors; and if peripheral Nociception (i.e. local tissue), is the driver for the sensation of pain then all clinical tests will stretch, traction and/or compress the subacromial bursae and other tissue.
Similarly, when evaluating imaging, Girish and colleagues (2011) displayed ultrasound scans on asymptomatic subjects and found shoulder abnormalities in 96% of subjects. Additionally, Frost et al (1999) used MRI scans to show there was no significant difference in imaging between symptomatic and asymptomatic subjects.