The Hawkins Kennedy Test is a widely recognized physical examination maneuver used by clinicians to assess the source of a patient’s shoulder pain. Named after orthopedic surgeons Dr. Richard Hawkins and Dr. Jon Kennedy who described it in the 1980s, this motion test helps evaluate the integrity of structures within the shoulder joint. It remains a staple diagnostic tool in sports medicine, physical therapy, and general orthopedic practice.
The Purpose of the Hawkins Kennedy Test
The primary objective of the Hawkins Kennedy Test is to screen for Subacromial Impingement Syndrome (SAIS). This syndrome involves the mechanical compression of soft tissues, such as the supraspinatus tendon or the subacromial bursa, as they pass beneath the acromion, the bony arch forming the top of the shoulder blade.
Subacromial Impingement occurs when the space between the humeral head and the acromion narrows, pinching the tissues during arm movements. The supraspinatus tendon, a part of the rotator cuff, and the fluid-filled bursa are particularly vulnerable to this compression. By forcing the shoulder into a specific position, the test aims to reproduce the patient’s pain, suggesting that impingement is a probable cause of their discomfort.
Executing the Test Maneuver
The patient should be seated or standing, allowing the arm to be relaxed at their side. The clinician begins by passively flexing the patient’s arm forward to 90 degrees of shoulder flexion. In this position, the elbow is bent at a right angle, with the forearm pointing forward.
The clinician stabilizes the patient’s elbow with one hand while grasping the wrist with the other. The examiner then applies a passive internal rotation to the shoulder joint. This motion is performed slowly until the patient experiences pain or the end of the available range of motion is reached. The test is entirely passive, requiring the patient to remain relaxed.
The internal rotation creates the mechanical stress required for the test. This movement is specifically chosen to minimize the space between the greater tuberosity of the humerus and the coracoacromial arch. The examiner notes the patient’s response and the degree of internal rotation achieved before pain is reported.
Interpreting a Positive Outcome
A positive result is defined by the reproduction of the patient’s familiar shoulder pain during the passive internal rotation. This pain typically occurs near the end range of movement, indicating the maneuver has successfully compressed structures in the subacromial space and suggesting a pathology.
The anatomical mechanism involves forced contact between the greater tuberosity of the humerus and the coracoacromial ligament. Internal rotation levers the tuberosity upward, pushing underlying soft tissues against the rigid arch. This forceful compression stresses the subacromial bursa and rotator cuff tendons, causing the sharp pain associated with impingement.
A positive finding suggests the pain is likely due to issues like rotator cuff tendinopathy or subacromial bursitis. Conversely, the absence of pain during the full range of motion makes the diagnosis of subacromial impingement less likely.
Context Within a Full Shoulder Examination
The Hawkins Kennedy Test is rarely used in isolation to establish a definitive diagnosis for shoulder pain. Clinical studies show the test has moderate to high sensitivity, meaning a negative result is useful for suggesting that impingement is not the cause of pain. However, its specificity is generally low, ranging from 56% to 67%.
A low specificity means that a positive result alone is not a guarantee of subacromial impingement, as other conditions can also cause pain in that position. For this reason, clinicians integrate the Hawkins Kennedy Test into a cluster of orthopedic examinations. Complementary tests, such as Neer’s sign or the painful arc test, are performed alongside it to increase diagnostic certainty.
The combination of patient history, symptom presentation, and a collection of positive and negative test results provides a more reliable clinical picture. If the physical examination suggests a high probability of impingement, the clinician may recommend further investigation, such as diagnostic imaging, to confirm the underlying structural cause.