What is the Hawkins–Kennedy test?

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Last updated: March 11, 2026 • View editorial policy

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Hawkins-Kennedy Test

The Hawkins-Kennedy test is a physical examination maneuver that elicits pain by forcibly internally rotating the patient's arm while it is passively flexed forward at 90 degrees, used to detect subacromial impingement and rotator cuff tendinopathy.

Test Technique

The examiner positions the patient's shoulder in 90 degrees of forward flexion, then forcibly internally rotates the humerus 1. This maneuver compresses the supraspinatus tendon and other rotator cuff structures against the coracoacromial ligament and anterior acromion.

Anatomical Basis

During the Hawkins-Kennedy position, cadaveric studies demonstrate:

  • Consistent contact between soft tissues and the coracoacromial ligament 2
  • Contact between the articular surface of rotator cuff tendons and the anterosuperior glenoid rim 2
  • Increased subacromial pressure at the coracoacromial ligament (impinging biceps brachii) and anterior acromion (impinging the rotator interval) 3

Importantly, structures other than just the rotator cuff tendons may be impinged during this test, including the biceps tendon and rotator interval 3.

Diagnostic Performance

Sensitivity and Specificity

  • Sensitivity: 88-92% for subacromial impingement 1, 4
  • Specificity: 25-33% (notably poor) 1
  • Negative predictive value: 96% when combined with Neer's test 4

Clinical Interpretation

The test's high sensitivity but low specificity means:

  • A negative test is useful for ruling out impingement (high negative predictive value)
  • A positive test alone cannot confirm the diagnosis (low positive predictive value, barely better than pretest probability) 4

Clinical Utility Considerations

The Hawkins-Kennedy test has limited standalone diagnostic value 5, 6. One study found it was the only impingement test without a significant area under the ROC curve 5, while another found it had 71% overall accuracy 6.

Recommended Approach

  • Use as part of a cluster of at least 3 positive tests out of 5 (Neer, Hawkins-Kennedy, painful arc, empty can, external rotation resistance) to confirm subacromial impingement syndrome 5
  • The painful arc, external rotation resistance, and empty can tests have superior diagnostic accuracy and should be prioritized 5
  • Reliability is fair (kappa = 0.39-0.40) 5, meaning moderate inter-examiner agreement

Common Pitfalls

  • Do not rely on this test alone to make treatment decisions given its poor specificity
  • A positive test may reflect pathology in multiple structures (rotator cuff, biceps, rotator interval), not just subacromial impingement 3
  • The test's positive predictive value is low, so positive findings require confirmation with imaging or additional clinical tests 4

References

2
Research

Anatomy of provocative tests for impingement syndrome of the shoulder.

Journal of shoulder and elbow surgery, 2000

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.