The Painful Arc test is commonly used to assess shoulder pain provocation during active arm elevation. It is often associated with subacromial pain presentations, rotator cuff irritation and shoulder loading sensitivity. This article explains the protocol, interpretation, limitations and practical assessment considerations.
Pain during shoulder elevation is one of the most common complaints in shoulder assessment. The Painful Arc test is frequently used to assess symptom behaviour during active arm movement and may help identify patterns associated with subacromial pain presentations.
The test is commonly used alongside:
shoulder ROM assessment
rotator cuff testing
strength assessment
scapular assessment
symptom history
functional movement assessment
Although a painful arc may increase suspicion of shoulder loading sensitivity in some populations, it should not be interpreted as a stand-alone diagnostic finding.
Primary purpose: Assess shoulder pain provocation during active elevation
Body region: Shoulder
Commonly associated with: Subacromial pain presentations and rotator cuff irritation
Positive finding: Pain during a specific range of shoulder elevation
Negative finding: Pain-free shoulder elevation
Clinical role: Supports assessment reasoning but does not confirm pathology independently
Best interpreted with: History, strength findings and broader shoulder assessment
The Painful Arc test is a shoulder movement assessment that evaluates symptom provocation during active arm elevation.
The client actively elevates the arm while the assessor observes:
pain location
painful ranges
movement quality
compensation patterns
symptom behaviour
Pain occurring during mid-range elevation is commonly associated with subacromial loading sensitivity.
The Painful Arc test may help:
reproduce shoulder symptoms
assess movement-related pain
identify painful movement ranges
monitor shoulder irritability
support shoulder assessment reasoning
It is commonly used in:
overhead athletes
gym-based populations
occupational shoulder assessment
return-to-training monitoring
The test is intended to assess:
pain during shoulder elevation
symptom behaviour during movement
shoulder loading tolerance
active movement quality
A painful response may be associated with:
rotator cuff irritation
subacromial pain presentations
bursae sensitivity
shoulder loading intolerance
However, the test does not confirm structural pathology independently.
The Painful Arc test may be useful for:
exercise professionals
sports performance settings
shoulder screening
movement assessment education
allied health assessment environments
shoulder monitoring
Consider using the Painful Arc test when a client reports:
pain during lifting
painful overhead activity
shoulder discomfort during elevation
painful pressing movements
shoulder movement sensitivity
Use caution when:
acute trauma is suspected
symptoms are highly irritable
severe pain is present
fracture is suspected
recent dislocation occurred
Stop testing if:
pain becomes excessive
neurological symptoms occur
movement becomes unsafe
Open assessment space
Documentation system
No specialised equipment is required.
The client stands in a relaxed position.
Standing
Arms by sides initially
Ask the client to actively elevate the arm.
Observe the movement through full available range.
Ask the client to report pain location and painful range.
Ask the client to:
raise the arm slowly
report painful ranges
describe symptoms
avoid forcing painful movement
A positive finding may involve:
pain during mid-range elevation
painful arc during shoulder abduction
symptom reproduction during movement
A negative finding involves pain-free active shoulder elevation.
A positive Painful Arc may increase suspicion of:
subacromial pain presentations
rotator cuff irritation
shoulder loading sensitivity
However, a painful arc does not confirm structural pathology independently.
Pain may also relate to:
stiffness
instability
movement apprehension
scapular dysfunction
A negative finding may reduce suspicion of movement-related shoulder pain sensitivity during elevation.
However:
symptoms may still occur during other tasks
shoulder pathology may still be present
irritability levels may vary daily
The Painful Arc test has demonstrated variable diagnostic accuracy across studies.
Research suggests:
the test may be more useful when combined with other shoulder findings
isolated shoulder orthopaedic tests often lack strong stand-alone accuracy
symptom reproduction alone is insufficient for diagnosis
More recent shoulder assessment literature supports combining:
history
movement assessment
strength findings
multiple test findings
Reliability may be influenced by:
movement speed
symptom irritability
movement compensation
assessor interpretation
Standardised instructions may improve repeatability.
Common errors include:
moving too quickly
poor symptom clarification
overinterpreting pain alone
ignoring movement quality
Limitations include:
variable specificity
overlap with multiple shoulder conditions
inconsistent painful ranges between individuals
The Painful Arc test may help:
monitor symptom behaviour
assess shoulder irritability
guide further assessment
track progress over time
Record:
Test name: Painful Arc
Side tested
Positive, negative or unclear
Painful range
Pain location
Pain score
Movement quality
Compensations
Comparison side findings
Related shoulder findings
Retest date
Related shoulder assessments may include:
Neer’s Test
Hawkins-Kennedy Test
Empty Can Test
O’Brien’s Test
Scapular Retraction Test
A positive finding may suggest shoulder loading sensitivity or subacromial pain-related symptoms.
No. The test may contribute to assessment reasoning but does not confirm pathology independently.
Pain commonly occurs during mid-range elevation, although this varies between individuals.
The Painful Arc assesses shoulder pain during active elevation.
A positive finding may indicate shoulder loading sensitivity.
The test does not confirm structural pathology independently.
The test is most useful alongside broader shoulder assessment findings.
Cook, C., & Hegedus, E. J. (2021). Orthopedic physical examination tests: An evidence-based approach (3rd ed.). Pearson.
Morrow, E. K., Morris, J. H., & Struyf, F. (2020). Clinical examination and physical assessment of shoulder pain. British Journal of Sports Medicine, 54(20), 1208–1215. https://doi.org/10.1136/bjsports-2019-101168
Pizzari, T., & Jaggi, A. (2021). Shoulder instability: Current approaches to assessment and management. Journal of Orthopaedic & Sports Physical Therapy, 51(7), 347–356. https://doi.org/10.2519/jospt.2021.0607
