Hawkins-Kennedy Impingement Sign

Purpose of Test: To test for subacromial impingement.

Test Position: Sitting or standing.

Performing the Test: The examiner places the patient’s shoulder into 90 degrees of shoulder flexion with the elbow flexed to 90 degrees. The therapist then passively internally rotates the patient’s arm. If the patient has pain with internal rotation, the test is considered positive.

Diagnostic Accuracy: Sensitivity: 92.1; Specificity: 25; +LR: 1.23; -LR: .32   (1)

Importance of Test: Placing the patient in 90 degrees of shoulder flexion and internal rotation decreases the space between the humeral head and underside of the acromion process. If this space is narrowed, structures in the subacromial space, such as the supraspinatus tendon or the subacromial bursa, will become compressed and elicit a pain respone.
 
It is important to note that this test performed alone does not have good diagnostic accuracy. A clinician should utilize the cluster for identifying subacromial impingement if they suspect a patient with this syndrome. The cluster consists of:  1. positive hawkins-kennedy impingement sign, 2. the painful arc sign, and 3. weak or painful infraspinatus manual muscle test.

Cluster Diagnostic Accuracy:
If all 3 tests are positive, the +LR increases to 10.56. (2)
If all 3 tests are negative, the -LR is .17
If ⅔ tests are positive, the +LR drops to 5.01. If ⅓ are positive, the +LR is .90.

Note: these tests should only be performed by properly trained health care practitioners.

References: “Diagnostic Values of clinical diagnostic tests in subacromial impingement syndrome." by Calis et al, 2000
"Users Guide to the Musculoskeletal Examination" by Timothy Flynn