What is the Hawkins Kennedy test used for?

The Hawkins-Kennedy Test for Shoulder Impingement

The Hawkins-Kennedy test is a highly sensitive clinical examination maneuver used to identify subacromial impingement syndrome in patients with shoulder pain.

What It Is

The Hawkins-Kennedy test is a physical examination technique that evaluates for shoulder impingement by positioning the patient's arm to create mechanical contact between the rotator cuff tendons and surrounding structures.

How to Perform the Test

1. Position the patient sitting or standing
2. Flex the patient's arm forward to 90 degrees
3. Forcibly internally rotate the shoulder while stabilizing the scapula
4. A positive test is indicated by pain during this maneuver

Diagnostic Value

• Sensitivity: Extremely high (88-92%) for detecting rotator cuff pathology and subacromial bursitis 1, 2
• Specificity: Relatively low (25-62%) 1, 2
• Clinical implication: The test is more useful for ruling out impingement than ruling it in
• When combined with other tests like the Neer sign, it has a high negative predictive value (96% for bursitis, 90% for rotator cuff tears) 1

Anatomical Basis

The Hawkins-Kennedy test works by creating mechanical contact between:

• The supraspinatus tendon and the anterosuperior glenoid rim
• The subscapularis tendon and the anterosuperior glenoid 3

This position narrows the space between the rotator cuff tendons and the anterosuperior labrum, which can reproduce pain in patients with impingement pathology 3.

Clinical Significance

The test is particularly valuable in evaluating patients with:

• Shoulder pain during overhead activities
• Pain with abduction and internal rotation
• Suspected rotator cuff tendinopathy
• Activity-related shoulder pain

Limitations

1. The test can produce false positives due to:

   • Internal impingement mechanisms being provoked during the test 3
   • Lack of specificity for distinguishing between different shoulder pathologies

2. While highly sensitive, the test should be interpreted in conjunction with:

   • Other clinical tests (Neer sign, empty can test)
   • Patient history
   • Imaging findings when appropriate

Common Pitfalls

• Misinterpreting a positive test as definitively diagnostic of subacromial impingement
• Failing to recognize that the test may also provoke internal impingement mechanisms 3
• Relying solely on this test without considering the complete clinical picture

Recommendations for Clinical Practice

• Use the Hawkins-Kennedy test as part of a comprehensive shoulder examination
• A negative test is more clinically valuable than a positive test due to its high sensitivity
• Consider complementary tests like the Neer sign to improve diagnostic accuracy
• Be aware that MRI findings may not always correlate with clinical impingement tests 4
• Standardize the testing procedure to improve reliability, as standardized performance has shown almost perfect agreement between examiners (Kappa 0.91-1.00) 5

In conclusion, the Hawkins-Kennedy test is a valuable clinical tool for evaluating shoulder pain, particularly for ruling out subacromial impingement syndrome when negative, though its positive predictive value is limited by its lower specificity.