What does the Hawkins-Kennedy test diagnose?

Hawkins-Kennedy Test: A Diagnostic Tool for Shoulder Impingement Syndrome

The Hawkins-Kennedy test is a clinical examination maneuver designed to diagnose subacromial impingement syndrome of the shoulder by reproducing pain through internal rotation of the humerus in a forward flexed position.

Test Procedure and Mechanism

The Hawkins-Kennedy test is performed as follows:

• The examiner positions the patient's arm at 90 degrees of forward flexion
• The examiner then forcibly internally rotates the shoulder
• A positive test is indicated by pain during this maneuver

This test works by narrowing the subacromial space, causing the supraspinatus tendon to be compressed between the greater tuberosity of the humerus and the coracoacromial arch 1. The test specifically evaluates for impingement of the rotator cuff tendons, particularly the supraspinatus.

Diagnostic Accuracy

The Hawkins-Kennedy test has the following diagnostic characteristics:

• High sensitivity (79%) but limited specificity (59%) for subacromial impingement 2
• Moderate reliability with kappa values of 0.54-0.56, indicating acceptable clinical utility 3

This means the test is more useful for screening (ruling out impingement when negative) than for confirming the diagnosis when positive.

Clinical Context and Interpretation

When interpreting the Hawkins-Kennedy test, clinicians should be aware of:

1. False positives: The test may also provoke anterosuperior internal impingement by creating contact between:

   • The subscapularis tendon and the anterosuperior glenoid (in 33 of 37 subjects)
   • The supraspinatus tendon and the anterosuperior glenoid (in 18 of 37 subjects) 4

2. Improved diagnostic value when combined with other tests:

   • The combination of Hawkins-Kennedy test, painful arc sign, and infraspinatus muscle test yields the best post-test probability (95%) for any degree of impingement syndrome 5
   • Using a cut point of 3 or more positive tests out of 5 common impingement tests (including Hawkins-Kennedy) significantly improves diagnostic accuracy 6

Clinical Recommendation

For optimal diagnostic accuracy when evaluating suspected shoulder impingement:

1. Use the Hawkins-Kennedy test as part of a comprehensive shoulder examination battery
2. Combine with other tests, particularly:
   • Painful arc test
   • External rotation resistance test
   • Empty can (Jobe) test

This approach provides the most reliable clinical diagnosis of subacromial impingement syndrome, with three or more positive tests strongly suggesting the presence of impingement 6.

Remember that the Hawkins-Kennedy test alone has moderate reliability and should not be used in isolation for definitive diagnosis of shoulder impingement syndrome.