Hawkins / Kennedy Impingement Test of the Shoulder

Purpose[edit | edit source]

This test is commonly used to identify possible subacromial impingement syndrome.

Technique[edit | edit source]

The examiner places the patient's arm shoulder in 90 degrees of shoulder flexion with the elbow flexed to 90 degrees and then internally rotates the arm. The test is considered to be positive if the patient experiences pain with internal rotation.[1]

This 20 minute video is a good overview of the shoulder joint.[2]

Evidence[edit | edit source]

Studies of specificity and sensitivity have varied significantly. Sensitivity has been reported at .62 - .92. Specificity has been reported to be .25 - 1.00[3]. A study in the Annals of Rheumatic Disease calculated the +LR of the Hawkins-Kennedy to be 1.23 and the -LR to be .32[4].

Diagnostic Test Properties for Hawkins-Kennedy Impingement Sign[5]
Sensitivity   0.62 - 0.92
Specificity   0.25 - 1.00
Positive Likelihood Ratio   1.20 - 3.33
Negative Likelihood Ratio   0.21 - 0.55

Test Item Cluster:
When this test is combined as a cluster with the Painful Arc Sign and the Infraspinatus test, and all three tests report a positive, then the positive likelihood ratio is 10.56 and if all three tests are negative, the negative likelihood ratio is .17. If two of the three tests are positive, then the positive likelihood ratio is 5.03.[3]

See test diagnostics page for explanation of statistics.

References[edit | edit source]

  1. 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
  2. Shoulder joint video - © Kenhub https://www.kenhub.com/en/study/anatomy-glenohumeral-joint
  3. 3.0 3.1 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.
  4. Mustafa et al. Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. Ann Rheum Dis 2000;59;44-47
  5. Dutton, M. (2008). Orthopaedic: Examination, evaluation, and intervention (2nd ed.). New York: The McGraw-Hill Companies, Inc.