The Hawkins Test is a physical examination maneuver used by healthcare professionals to assess shoulder pain. It serves as a preliminary tool in orthopedic evaluations to identify potential issues within the shoulder joint. This test helps guide further investigation into the source of a patient’s symptoms, particularly when impingement is suspected.
Understanding the Hawkins Test
A healthcare professional performs the Hawkins Test with the patient either seated or standing. The examiner positions the patient’s arm by flexing the shoulder forward to 90 degrees, with the elbow also bent to 90 degrees. While supporting the elbow and wrist, the examiner then passively rotates the arm internally. This maneuver is designed to provoke symptoms by compressing structures within the subacromial space of the shoulder. It aims to reproduce the patient’s pain.
What a Positive Hawkins Test Indicates
A positive Hawkins Test occurs when the maneuver reproduces pain in the patient’s shoulder. This pain suggests shoulder impingement syndrome, a condition involving the pinching or rubbing together of soft tissues as they pass through the subacromial space, located between the acromion and the humeral head.
Specifically, the test points to potential impingement of the supraspinatus tendon or the subacromial bursa. The internal rotation component of the test narrows this space, causing compression and eliciting pain if inflammation or irritation is present. Other structures, such as the long head of the biceps tendon, can also be involved in this compression. Pain during this test can signify tendinitis of the supraspinatus tendon or inflammation of the subacromial bursa.
Next Steps After a Positive Test
Following a positive Hawkins Test, a comprehensive clinical evaluation is conducted to confirm the diagnosis and identify the cause of shoulder pain. This evaluation includes a detailed medical history, additional physical examinations, and sometimes imaging studies. X-rays may be used to identify bony abnormalities like bone spurs, while Magnetic Resonance Imaging (MRI) provides detailed views of soft tissues, such as tendons and bursae, revealing inflammation or tears.
Initial management strategies for shoulder impingement involve conservative approaches. These include rest, activity modification, and anti-inflammatory medications to reduce pain and swelling. Physical therapy plays a role, focusing on exercises to restore normal motion and strengthen shoulder muscles.
For persistent symptoms, corticosteroid injections may be considered to reduce localized inflammation. If conservative measures do not provide adequate relief, surgical options like subacromial decompression, which widens the space for tendons, may be explored. The Hawkins Test serves as an indicator, but a definitive diagnosis relies on a thorough assessment by a healthcare professional.