The Hawkins test is a common physical examination maneuver used by healthcare professionals to assess for shoulder problems. It serves as a clinical screening tool to identify potential issues within the shoulder. This test is one of several assessments a doctor might perform to understand the source of a patient’s shoulder pain or limited movement.
Identifying Shoulder Impingement
Shoulder impingement occurs when soft tissues within the shoulder are compressed or “pinched” between bony structures. This often involves the rotator cuff tendons, particularly the supraspinatus tendon, and the subacromial bursa. These structures pass through a narrow space beneath the acromion, a bony projection. When the arm is raised, this subacromial space naturally narrows.
Factors contributing to impingement include inflammation of the rotator cuff tendons (tendinitis) or the bursa (bursitis), or structural variations in the acromion, such as a curved or hooked shape. Repetitive overhead arm movements, common in certain sports or occupations, can also lead to irritation and swelling, further reducing the space. This compression can cause pain, weakness, and restricted motion in the shoulder.
Performing the Hawkins Test
To perform the Hawkins test, the patient typically sits or stands. The examiner positions the patient’s arm with the shoulder and elbow flexed to 90 degrees. The examiner stabilizes the patient’s shoulder or elbow with one hand, then grasps the patient’s forearm or wrist with the other to passively rotate the arm inward (internal rotation).
This internal rotation pushes the greater tuberosity of the humerus toward the coracoacromial ligament and the acromion. This action aims to compress structures in the subacromial space. The test is complete when resistance is felt or the patient reports pain.
Understanding Test Results
A positive Hawkins test is indicated by the reproduction of the patient’s familiar shoulder pain during internal rotation. This suggests that structures within the subacromial space, such as the supraspinatus tendon or the subacromial bursa, are being compressed. This can signify tendinitis, bursitis, or other irritation within this area.
A negative Hawkins test means the patient does not experience pain, suggesting a lower likelihood of impingement syndrome. However, the Hawkins test is not definitive; it is a provocative test that attempts to reproduce symptoms, but a positive result does not solely confirm a diagnosis. Its accuracy varies, as its sensitivity and specificity are not consistently high.
Healthcare providers use the Hawkins test as part of a comprehensive physical examination, often combining it with other tests to enhance diagnostic accuracy. If positive, further diagnostic steps may include additional clinical tests, imaging studies (X-rays, ultrasound, or MRI), and a thorough review of the patient’s medical history and symptoms. This integrated approach helps confirm the diagnosis or rule out other causes of shoulder pain.