Shoulder discomfort is a common complaint that can significantly affect daily activities and quality of life. Identifying the precise source of this pain often requires a thorough clinical assessment by healthcare professionals. Such assessments typically involve a combination of patient history, observation, and various physical examination tests designed to pinpoint specific conditions or structures involved. These diagnostic tools help differentiate between various causes of shoulder pain, guiding appropriate management strategies.
Identifying Shoulder Impingement
Shoulder impingement refers to the compression of soft tissues, such as the rotator cuff tendons or the bursa, within the subacromial space of the shoulder joint. This narrow area is located between the top of the humerus (upper arm bone) and the acromion, which is a bony projection of the shoulder blade. When the arm is raised, particularly overhead, these soft tissues can become pinched against the acromion, leading to inflammation and pain. This compression mechanism often results from repetitive overhead activities, changes in shoulder mechanics, or anatomical variations in the acromion shape.
The Hawkins-Kennedy test is a specific physical examination maneuver designed to provoke symptoms associated with subacromial impingement. It is one of several clinical tests used to help diagnose this condition by intentionally narrowing the subacromial space. The test aims to reproduce the patient’s typical shoulder pain, suggesting that the structures within this space are being compressed. While it does not definitively diagnose impingement on its own, a positive result from this test provides a strong indication of its presence.
Performing the Examination
To perform the Hawkins-Kennedy test, the patient typically sits or stands comfortably while the examiner stabilizes their shoulder. The examiner then passively flexes the patient’s arm forward to 90 degrees at the shoulder, with the elbow also bent at 90 degrees. The examiner then supports the patient’s elbow with one hand and grasps the patient’s forearm or wrist with the other.
From this flexed position, the examiner internally rotates the patient’s arm. This internal rotation causes the greater tuberosity of the humerus, where some rotator cuff tendons attach, to move closer to the coracoacromial ligament and the anterior acromion. The test is considered complete when the maximum internal rotation is achieved or when the patient experiences pain, whichever comes first.
Understanding Test Outcomes
A positive result from the Hawkins-Kennedy test is indicated by the reproduction of the patient’s familiar shoulder pain, particularly as the arm is internally rotated to its end range of motion. This pain occurs because the maneuver effectively compresses the rotator cuff tendons, primarily the supraspinatus, and the subacromial bursa against the undersurface of the acromion and the coracoacromial ligament. However, a positive test does not specify which particular structure within the subacromial space is affected.
Conversely, a negative Hawkins-Kennedy test occurs when the patient does not experience any pain during the internal rotation maneuver. While a negative result makes subacromial impingement less likely, it does not completely rule out the condition. Therefore, no single physical examination test provides a definitive diagnosis for shoulder impingement.
The interpretation of the Hawkins-Kennedy test results always requires correlation with other clinical findings. Healthcare professionals consider the patient’s medical history, including the onset and nature of their pain, and the results of other physical examination tests. Imaging studies, such as X-rays to assess bone structure or MRI to visualize soft tissues, are often used to confirm the diagnosis and identify the extent of tissue damage. A comprehensive evaluation ensures an accurate diagnosis and guides the most effective treatment plan for shoulder pain.