Hawkins-Kennedy Impingement Test: What a Positive Result Means for Shoulder Pain

What is a Positive Hawkins Test?

A positive Hawkins Test, more formally known as the Hawkins-Kennedy Impingement Test, indicates potential subacromial impingement syndrome in the shoulder, where structures like the rotator cuff tendons (most commonly the supraspinatus) are compressed within the subacromial space.

Understanding the Hawkins-Kennedy Impingement Test

The Hawkins-Kennedy Impingement Test is a widely utilized orthopedic special test designed to assess for subacromial impingement syndrome within the shoulder joint. This condition arises when soft tissues, particularly the rotator cuff tendons (and sometimes the subacromial bursa), become compressed or "pinched" between the head of the humerus and the overlying acromion and coracoacromial arch during specific arm movements. The test aims to intentionally narrow this space to provoke symptoms if impingement is present.

Anatomy and Biomechanics Behind the Test

To grasp the mechanics of the Hawkins Test, it's crucial to understand the relevant shoulder anatomy:

• Subacromial Space: This narrow anatomical region lies between the head of the humerus below and the acromion, coracoacromial ligament, and coracoid process above. It houses the supraspinatus tendon (part of the rotator cuff) and the subacromial bursa.
• Supraspinatus Tendon: This rotator cuff tendon passes through the subacromial space and is particularly vulnerable to compression due to its location and function in initiating arm abduction.
• Coracoacromial Arch: Formed by the acromion, coracoid process, and the coracoacromial ligament that spans between them, this arch acts as the superior boundary of the subacromial space.

The test positions the arm in a way that maximizes the compression of the supraspinatus tendon against the coracoacromial ligament and the anterior aspect of the acromion, thereby eliciting pain if these structures are inflamed or impinged.

How the Hawkins-Kennedy Test is Performed

The Hawkins-Kennedy test is typically performed by a clinician (e.g., physician, physical therapist, athletic trainer) on a patient suspected of shoulder impingement.

• Patient Positioning: The patient is usually seated or standing comfortably.
• Examiner Positioning and Hand Placement: The examiner stands beside the patient, supporting the tested arm. One hand stabilizes the patient's elbow, while the other hand grasps the patient's wrist or forearm.
• Execution of the Movement:
  1. The examiner passively flexes the patient's shoulder to 90 degrees.
  2. The elbow is also flexed to 90 degrees.
  3. The examiner then maximally internally rotates the humerus (forearm moves downwards and inwards) while maintaining the 90-degree flexion at the shoulder and elbow.

This internal rotation maneuver forces the greater tuberosity of the humerus and the attached supraspinatus tendon directly underneath the coracoacromial ligament and the anterior acromion, compressing the structures within the subacromial space.

Interpreting a Positive Hawkins Test

A positive Hawkins Test is indicated by the reproduction of the patient's familiar shoulder pain, particularly sharp pain felt in the anterior or lateral aspect of the shoulder, during the internal rotation maneuver.

• Clinical Significance: A positive result suggests the presence of subacromial impingement syndrome. This could involve:

  • Supraspinatus Tendinopathy/Tendinitis: Inflammation or degeneration of the supraspinatus tendon.
  • Subacromial Bursitis: Inflammation of the subacromial bursa.
  • Rotator Cuff Tendinopathy: General inflammation or irritation of other rotator cuff tendons that also pass through this space.

• Differential Diagnosis: While the Hawkins Test is sensitive for impingement, it is not highly specific. This means that while many people with impingement will have a positive test (high sensitivity), a positive test alone doesn't definitively rule out other shoulder pathologies. Other conditions such as AC joint pathology, biceps tendinopathy, or even cervical spine issues can sometimes refer pain to the shoulder region and might coincidentally be provoked by similar movements. Therefore, it's always used in conjunction with a thorough history, other physical examination tests (e.g., Neer's Impingement Test, Empty Can Test), and sometimes imaging studies (X-ray, MRI) for a definitive diagnosis.

Limitations and Considerations

While valuable, the Hawkins Test has limitations:

• Specificity: As mentioned, its specificity is moderate, meaning it can sometimes be positive in individuals without true subacromial impingement or for other reasons.
• Pain Tolerance: Patient's pain tolerance and apprehension can influence results.
• Acute vs. Chronic: The test is often more provocative in acute inflammatory conditions.
• Examiner Skill: Proper technique by the examiner is crucial for accurate results.

No single special test should be used in isolation to diagnose a condition. A comprehensive clinical assessment is always necessary.

What to Do After a Positive Test

If you experience shoulder pain during movements similar to the Hawkins Test, or if a clinician performs the test and it elicits your pain, it is a strong indicator that further evaluation is warranted.

• Seek Professional Medical Advice: Consult with a physician, physical therapist, or other qualified healthcare professional. They can conduct a thorough examination, including additional special tests and potentially imaging (like an MRI) to confirm a diagnosis.
• Avoid Provocative Movements: While awaiting a diagnosis, try to avoid movements that exacerbate your shoulder pain.
• Conservative Management: Treatment for subacromial impingement often begins with conservative approaches, including rest, anti-inflammatory medications, physical therapy (focusing on rotator cuff strengthening, scapular stability, and posture), and activity modification. In some cases, corticosteroid injections or surgery may be considered if conservative measures fail.

Understanding the Hawkins Test provides insight into one of the key diagnostic tools used for shoulder pain, emphasizing the importance of a structured, evidence-based approach to assessing musculoskeletal conditions.