Hawkins Kennedy Test – Orthopedic Shoulder Examination

The Hawkins-Kennedy test (also called the Hawkins test or Hawkins Impingement test) is one of the most widely used special tests in shoulder assessment. It is primarily used to identify subacromial impingement syndrome — compression of structures in the subacromial space during shoulder movement. The test is valued for its high sensitivity, making it a useful screening tool when shoulder impingement is suspected.

What Is Subacromial Impingement Syndrome?

Subacromial impingement syndrome refers to compression of soft tissue structures — most commonly the supraspinatus tendon and subacromial bursa — beneath the acromion and coracoacromial arch during shoulder elevation. It is one of the most common causes of shoulder pain in clinical practice, particularly in overhead athletes, manual workers, and older adults.

Symptoms typically include pain at the anterolateral aspect of the shoulder, aggravated by overhead activities, and a characteristic painful arc of shoulder elevation between approximately 60 and 120 degrees. Weakness and limited range of motion may also be present in more severe cases involving rotator cuff pathology.

Involved Structures

The Hawkins-Kennedy test provokes compression within the subacromial space. The structures most commonly implicated in a positive test include:

• Supraspinatus tendon — the most commonly involved structure; runs beneath the acromion and is vulnerable to compression with internal rotation
• Subacromial bursa — a fluid-filled sac that can become inflamed and contribute to pain
• Long head of biceps tendon — passes through the bicipital groove and can be irritated in the impingement position
• Acromioclavicular joint — may refer pain into the same region, creating diagnostic ambiguity

How to Perform the Hawkins-Kennedy Test

Starting Position

The patient is seated in a relaxed position with the examiner standing to the side. The examiner passively moves the patient’s arm to 90 degrees of forward flexion with the elbow bent to 90 degrees, creating a horizontal arm position.

Test Movement

From this position, the examiner applies firm overpressure into shoulder internal rotation, rotating the arm downward until end range or until the patient reports pain. This movement drives the greater tuberosity and supraspinatus tendon beneath the coracoacromial arch, compressing the subacromial structures.

Positive Test

A positive Hawkins-Kennedy test is indicated by pain reproduced at the superior-lateral aspect of the shoulder during or at the end of the internal rotation movement. The pain should correspond to the patient’s familiar symptoms to be clinically meaningful.

Diagnostic Accuracy

• Sensitivity: 92% for subacromial bursitis; 88% for rotator cuff tear
• Specificity: 62%
• Interexaminer reliability: 0.36–0.38 (moderate)

The high sensitivity means this test is most useful for ruling out subacromial impingement: a negative Hawkins-Kennedy result makes the diagnosis less likely. However, the moderate specificity means a positive result alone is not sufficient to confirm the diagnosis. False positives can occur with AC joint pathology, biceps tendinopathy, and glenohumeral instability.

The moderate interexaminer reliability (kappa 0.36–0.38) suggests results can vary between clinicians, particularly in how much force is applied during internal rotation. Consistent technique matters.

Hawkins-Kennedy vs. Neer Test

Both tests assess subacromial impingement but use different mechanisms to provoke compression. The Neer test elevates the arm in forward flexion to compress structures against the anterior acromion. The Hawkins-Kennedy test uses internal rotation at 90 degrees of forward flexion to drive structures beneath the coracoacromial arch.

Some research suggests the Neer test is more accurate overall; other studies show comparable performance between the two. In clinical practice they are often used together. A positive result on both increases the likelihood of true subacromial impingement. When results conflict, other clinical findings and imaging should guide interpretation.

Clinical Pearls

• The high sensitivity makes this test most useful for ruling out impingement. A negative result is more informative than a positive one.
• Use consistent force during internal rotation. A gentle movement may miss the pathology.
• Pain localized to the AC joint rather than the superolateral shoulder suggests AC joint pathology, not subacromial impingement.
• Combine with the Neer test and Painful Arc test for a more complete shoulder impingement assessment.
• A positive result alone does not differentiate subacromial bursitis, supraspinatus tendinopathy, or rotator cuff tear — additional testing is needed.

Video Demonstration

Related Shoulder Tests

• Neer Test: the standard companion impingement test; uses forward flexion and internal rotation to target the same subacromial space
• Painful Arc Test: active assessment of subacromial impingement through range of motion
• Drop Arm Test: differentiates supraspinatus tear from impingement when weakness is present

See all shoulder orthopedic special tests.

Frequently Asked Questions

What does the Hawkins-Kennedy test diagnose?

The Hawkins-Kennedy test is used to identify subacromial impingement syndrome — compression of the supraspinatus tendon and subacromial bursa beneath the acromion during shoulder movement. A positive test does not differentiate between bursitis, tendinopathy, or rotator cuff tear; further assessment is required to distinguish these.

What does a positive Hawkins-Kennedy test mean?

A positive result means pain was reproduced at the superior-lateral shoulder during internal rotation from 90 degrees of forward flexion. It is consistent with subacromial bursitis or supraspinatus pathology, but should be interpreted alongside the patient’s history, other shoulder tests, and imaging where appropriate.

How accurate is the Hawkins-Kennedy test?

The test has a sensitivity of approximately 88–92%, meaning it detects most cases of subacromial impingement when present. Its specificity is approximately 62%, meaning roughly one in three positive results may occur without true impingement. It is best used as a screening tool — a negative result helps rule out impingement, while a positive result warrants further investigation.

What is the difference between the Hawkins-Kennedy test and the Neer test?

Both tests assess subacromial impingement but use different mechanics. The Neer test elevates the arm into full forward flexion with the shoulder internally rotated. The Hawkins-Kennedy test holds the arm at 90 degrees of forward flexion and adds a forceful internal rotation. Using both tests together improves diagnostic confidence.

Can the Hawkins-Kennedy test give a false positive?

Yes. False positives can occur with AC joint pathology, biceps tendinopathy, glenohumeral instability, and referred pain from the cervical spine. This is why the test’s specificity is moderate — a positive result alone is not diagnostic and must be interpreted in context.

What should I do if the Hawkins-Kennedy test is positive?

A positive result warrants further assessment: rotator cuff strength testing, range of motion assessment, and potentially imaging (ultrasound or MRI) if symptoms are persistent or severe. Physiotherapy is typically the first line of management, focusing on rotator cuff strengthening, postural correction, and activity modification.