Hawkins-Kennedy Impingement Test
- Fysiobasen
- Oct 4
- 3 min read
The Hawkins-Kennedy Impingement Test is used to identify subacromial impingement syndrome, a condition in which shoulder structures such as the supraspinatus tendon and subacromial bursa become compressed between the acromion and the humeral head¹. This test is one of the most widely used provocative maneuvers in the clinical assessment of shoulder pain.
Technique
The test is performed with the patient either seated or standing.
Patient position: The arm is elevated to 90 degrees of shoulder abduction with the elbow flexed to 90 degrees.
Execution: The examiner stabilizes the patient’s arm and then applies a passive internal rotation of the shoulder.
A test is considered positive if the patient reports pain during this movement¹.
This pain response reflects narrowing of the subacromial space, which can irritate soft tissues such as the supraspinatus tendon, subacromial bursa, or long head of the biceps tendon.
Interpretation of Results
Positive test: Pain reproduced during internal rotation → suggests subacromial impingement, and may reflect irritation or inflammation of supraspinatus, bursa, or biceps tendon.
Negative test: No pain reported → impingement becomes less likely, though cannot be fully excluded.
A positive finding alone is not sufficient for a conclusive diagnosis, but it adds value when interpreted in the clinical context.
Diagnostic Accuracy
The Hawkins-Kennedy Test has shown variable accuracy across studies²³⁴. To better illustrate, the following table summarizes its diagnostic parameters:
Parameter | Reported Value | Clinical Implication |
Sensitivity | 62–92% | Good ability to detect impingement (useful for screening) |
Specificity | 25–100% | Wide variation; a positive test alone is not definitive |
Positive LR (+LR) | 1.20–3.33 | Moderate diagnostic value if positive |
Negative LR (–LR) | 0.21–0.55 | Good ability to rule out impingement if negative |
In summary: high sensitivity makes the test valuable for detecting impingement, but low specificity limits its stand-alone diagnostic reliability.
Test Item Cluster
The Hawkins-Kennedy Test becomes significantly more reliable when combined with other shoulder impingement tests²³:
Painful Arc Sign
Infraspinatus Test
Cluster interpretation:
Three positive tests: +LR = 10.56 → strong probability of impingement.
Three negative tests: –LR = 0.17 → strong probability that impingement is not present.
Two positive tests: +LR = 5.03 → moderate diagnostic value.
This cluster approach is strongly recommended for clinical practice.
Clinical Relevance
The Hawkins-Kennedy Test should be understood as part of a test battery rather than a diagnostic endpoint. It is particularly helpful:
In athletes performing repetitive overhead movements (swimming, tennis, throwing sports).
In patients with chronic shoulder pain, where subacromial impingement is suspected.
When interpreted alongside patient history, physical examination, and other provocative tests, it provides strong clinical value.
Summary
High sensitivity → effective screening tool.
Low specificity → cannot confirm impingement alone.
Strong diagnostic accuracy when combined with Painful Arc Sign and Infraspinatus Test.
Best used within a cluster of tests for shoulder evaluation.
References
Flynn, T.W., Cleland, J.A., Whitman, J.M. (2008). User's guide to the musculoskeletal examination: Fundamentals for the evidence-based clinician. Buckner, Kentucky: Evidence in Motion
Shoulder joint video - © Kenhub https://www.kenhub.com/en/study/anatomy-glenohumeral-joint
Park, H.B., Yokota, A., Gill, H.S., EI RG, McFarland, E.G. (2005). Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg Am, 87(7), 1446-1455.
Mustafa et al. Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. Ann Rheum Dis 2000;59;44-47
Dutton, M. (2008). Orthopaedic: Examination, evaluation, and intervention (2nd ed.). New York: The McGraw-Hill Companies, Inc.
