Objectives: The aim of this review was to systematically review the cost-effective diagnostic utility of clinical tests to diagnose subacromial impingement syndrome. Data Sources: The following electronic databases: Medline, EMBASE, Science Direct and the Cochrane Library were searched in June 2020 to identify the studies that investigated the diagnostic accuracy of clinical tests to diagnose SAIS. The search was restricted to articles written in English. Study Selection: This study included diagnostic accuracy of cohort studies that directly compared the diagnostic utility of clinical tests for diagnosing SAIS against either surgical or indirect imaging reference standards. The PRISMA guidelines were followed to accomplish this review. Two reviewers independently performed the study?s methodological quality assessment by using the QUADAS tool. Data Extraction: The sensitivity and specificity for each clinical test waa extracted from the included studies and both positive and negative likelihood ratios were tabulated either direct from available studies or calculated from the provided sensitivity and specificity data. Data Synthesis: This review included 14 studies in total of 1756 shoulders and considered standard, modi?ed and novel clinical tests for making a differential diagnosis on SAIS. In this review, included studies? overall methodological quality is high and there appears to be the diagnostic utility of the subacromial grinding test, lift-off, bear-hug and belly-off tests provide significant evidence to rule in SAIS when the tests are positive. Conclusion: This is an updated study of a previous systematic review on the diagnostic accuracy of clinical tests for SAIS. Making a precise differential diagnosis will ultimately ensure the appropriate therapeutic interventions, subsequently successful prognosis on SAIS patients thus, this review findings of diagnostic utility clinical tests need to be considered in the context of clinical practice of the overall patient assessment.