The Hawkins Kennedy test is employed to assess shoulder impingement. during this test, the clinician stabilizes the shoulder with one hand and, with the patient’s elbow flexed at 90 degrees, internally rotates the shoulder using the opposite hand. Shoulder pain elicited by internal rotation represents a positive test.
Originally described in 1980 the Hawkins and Kennedy test was interpreted as indicative of impingement between the greater tuberosity of the humerus against the correct-humeral ligament, trapping all those structures which intervene. it’s been reported as less reliable than the Neer impingement test.
Hawkins-Kennedy test: Forcefully internally rotate a 90° forwardly flexed arm, causing the supraspinatus tendon to impinge against the coracoacromial ligamentous arch. Note: Pain and a grimacing countenance indicate impingement of the supraspinatus tendon, indicating a positive Neer/Hawkins impingement sign. A test is taken into account positive if it elicits an equivalent pain you have been experiencing in your shoulder. The Neer test, Vighetti said, will often get a positive result, because it forces the arm into full flexion
Test
The patient is examined in sitting with their arm at 90° and their elbow flexed to 90°, supported by the examiner to make sure maximal relaxation. The examiner then stabilizes proximal to the elbow with their outside hand and with the opposite holds just proximal to the patient’s wrist. They then quickly move the arm into internal rotation.
Positive
Pain located in the sub-acromial space
False Positive
- Internal impingement Macdonald et al (2000)
- Bankart 25%
- SLAP 46.1 %
Research
Valatie et al (cadaver study) describe consistent contact between the soft tissues and the coracoacromial ligament and between the articular surface of the rotator cuff and the anterior superior glenoid during the Hawkin’ s and Kennedy test. Edelson and Teitz (2000) examined a large number of skeletal specimens and reported contact between the lesser tuberosity and anterosuperior glenoid in the Hawkin’ s and Kennedy test position.
| Sensitivity | Specificity | Accuracy | PPV | NPV | |
| Calis et al (%) | 92.1 | 25 | 72.8 | 75.2 | 56.2 |
| Ure et al (%) | 62 | 69 | NA | NA | NA |
Roberts et al(2002) used MRI to identify and measure the changes in anatomic structures in the subacromial space as the arm was moved from complete rest to 160° of forwarding flexion during the Hawkin’s and Neer impingement maneuvers. The rotator cuff insertion appeared to be in closest proximity to the anteroinferior acromion not at full elevation (Neer sign position) but at 90° of flexion (Hawkin’s sign position). They concluded that their data suggested that a clinically positive Hawkin’ s sign is consistent with external shoulder impingement.
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