Hawkins-Kennedy Test: Purpose, Procedure, Interpretation, and Significance

What does Hawkins test for?

The Hawkins-Kennedy test is a common orthopedic special test primarily used to assess for subacromial impingement syndrome in the shoulder, particularly involving the supraspinatus tendon and subacromial bursa.

Introduction to the Hawkins-Kennedy Test

The Hawkins-Kennedy test, often simply referred to as the Hawkins test, is one of several clinical examination maneuvers designed to evaluate the integrity and health of the shoulder joint. Developed by orthopedists Richard J. Hawkins and Patrick J. Kennedy, this test is widely employed by clinicians, physical therapists, and athletic trainers to help identify potential sources of anterior or lateral shoulder pain, specifically those related to impingement within the subacromial space. Understanding its mechanism provides valuable insight into the biomechanics of shoulder dysfunction.

Anatomy Involved

To appreciate the Hawkins-Kennedy test, a brief review of key shoulder anatomy is beneficial:

• Rotator Cuff: A group of four muscles (supraspinatus, infraspinatus, teres minor, subscapularis) and their tendons that stabilize the glenohumeral joint and facilitate shoulder movement. The supraspinatus tendon is particularly vulnerable to impingement due to its location.
• Subacromial Space: The narrow space between the humeral head below and the acromion (a bony projection of the scapula) and coracoacromial ligament above.
• Subacromial Bursa: A fluid-filled sac located within the subacromial space, reducing friction between the rotator cuff tendons and the overlying bone.
• Greater Tuberosity: A bony prominence on the humerus where the supraspinatus, infraspinatus, and teres minor tendons attach.

Impingement occurs when structures within the subacromial space, such as the rotator cuff tendons (especially supraspinatus) or the subacromial bursa, are compressed or "pinched" against the acromion or coracoacromial ligament during certain shoulder movements.

How the Test is Performed

The Hawkins-Kennedy test is typically performed with the patient seated or standing. The examiner assists the patient through the following steps:

1. Flexion: The examiner passively flexes the patient's arm forward to 90 degrees.
2. Adduction: The arm is then adducted across the body, maintaining 90 degrees of flexion. This positions the humerus in a way that begins to narrow the subacromial space.
3. Internal Rotation: While maintaining the position, the examiner grasps the patient's forearm and passively internally rotates the humerus at the shoulder joint. This is the critical provocative maneuver.

During the internal rotation, the greater tuberosity of the humerus, where the supraspinatus tendon inserts, is driven upward and anteriorly, effectively "jamming" it against the anterior aspect of the acromion and the coracoacromial ligament. This compression can irritate or entrap the structures within the subacromial space.

Interpreting the Results

The Hawkins-Kennedy test is considered positive if the patient reports reproduction of their typical shoulder pain during the internal rotation maneuver. The pain is usually felt in the anterior or lateral aspect of the shoulder. It's crucial for the clinician to note the quality, location, and intensity of the pain, and to distinguish it from simple discomfort or stretch.

Clinical Significance and Limitations

A positive Hawkins-Kennedy test is highly suggestive of subacromial impingement syndrome. This syndrome is a common cause of shoulder pain, often resulting from repetitive overhead activities, poor posture, or anatomical variations.

However, it's vital to understand that:

• Sensitivity and Specificity: While widely used, the Hawkins-Kennedy test, like many orthopedic special tests, has moderate sensitivity and specificity. This means it can produce false positives (positive test without impingement) or false negatives (impingement present but test is negative).
• Not Definitive: A positive test alone is rarely sufficient for a definitive diagnosis. It should always be interpreted in conjunction with the patient's history, symptom presentation, other physical examination findings (e.g., range of motion, strength testing, other impingement tests like Neer's test or painful arc sign), and sometimes imaging studies (X-ray, MRI).
• Differential Diagnosis: Pain during the Hawkins-Kennedy test could also, less commonly, be associated with other conditions such as:
  • Rotator cuff tendinopathy or tear: The impingement mechanism can exacerbate an already compromised tendon.
  • Subacromial bursitis: Inflammation of the bursa.
  • Acromioclavicular (AC) joint pathology: While less common for the Hawkins test, it's important to rule out AC joint pain as a primary source, which can sometimes be provoked by similar adduction/internal rotation movements.

What a Positive Test Might Indicate

A positive Hawkins-Kennedy test most commonly points to irritation or compression of:

• Supraspinatus Tendon: The most frequently impinged rotator cuff tendon.
• Subacromial Bursa: Inflammation of the bursa due to compression.

The pain arises from the mechanical compression of these structures against the bony and ligamentous roof of the subacromial space.

Beyond the Hawkins Test

For a comprehensive assessment of shoulder pain, an "Expert Fitness Educator" or clinician would not rely solely on the Hawkins-Kennedy test. A thorough examination includes:

• Patient History: Detailed information about the onset, nature, location, and aggravating/alleviating factors of the pain.
• Observation: Assessing posture, muscle atrophy, and shoulder symmetry.
• Range of Motion: Active and passive range of motion in all planes.
• Strength Testing: Evaluating the strength of individual rotator cuff muscles and deltoid.
• Palpation: Identifying areas of tenderness.
• Other Special Tests: Including Neer's Impingement Test, Empty Can Test (Supraspinatus Test), Painful Arc Sign, Cross-Body Adduction Test (for AC joint), and various tests for rotator cuff tears or labral pathology.

Conclusion

The Hawkins-Kennedy test is a valuable tool in the clinical assessment of shoulder pain, primarily indicating subacromial impingement syndrome. It effectively reproduces pain by mechanically compressing the vulnerable structures within the subacromial space. While a positive test provides a strong clue, it is just one piece of the diagnostic puzzle. A holistic approach, combining detailed patient history, a comprehensive physical examination, and consideration of other diagnostic tests, is essential for an accurate diagnosis and effective management plan for shoulder pathology.