The Hawkins Test, also known as the Hawkins-Kennedy Test, is a common technique used during a physical examination to determine the source of shoulder pain. Clinicians employ this maneuver when a patient reports discomfort, weakness, or limited motion. It is a “provocative test,” designed to intentionally reproduce the patient’s familiar pain in a controlled manner. By generating pain through a specific motion, the test suggests a probable diagnosis, guiding the practitioner toward effective next steps in treatment.
Executing the Test Maneuver
The procedure involves placing the patient’s arm into a specific position to narrow the space within the shoulder joint. The patient is typically examined while sitting, with the shoulder flexed forward to 90 degrees and the elbow bent to a right angle. This starting position brings the humerus, or upper arm bone, forward and slightly upward toward the shoulder’s bony roof.
From this position, the examiner stabilizes the shoulder while gently forcing the patient’s forearm downward. This action causes the arm to internally rotate at the shoulder joint. The test is considered positive if this maneuver reproduces the patient’s characteristic shoulder pain, typically felt in the front or side of the shoulder.
Understanding Shoulder Impingement
A positive Hawkins Test strongly suggests the presence of subacromial impingement syndrome, which is the most common cause of shoulder pain. Impingement occurs when the soft tissues passing through a narrow space beneath the acromion (the bony arch at the top of the shoulder blade) get pinched or squeezed. Within this space lie the rotator cuff tendons, most notably the supraspinatus tendon, and the fluid-filled subacromial bursa.
The forced internal rotation during the test drives the head of the humerus upward and forward. This movement mechanically narrows the subacromial space, causing the supraspinatus tendon and bursa to be compressed against the acromion and the coracoacromial ligament. The resulting sharp or pinching pain confirms that these compressed structures are the source of the patient’s symptoms.
Impingement can involve inflammation of the bursa (bursitis) or irritation and tendinopathy of the rotator cuff tendons. While the Hawkins Test is highly sensitive for identifying a mechanical problem, it is often used alongside other physical examination techniques to distinguish impingement from other conditions, such as a full-thickness rotator cuff tear.
Impingement can result from several factors, including bony spurs developing on the acromion or muscle imbalance and weakness. If the rotator cuff muscles are not functioning properly, the head of the humerus may migrate slightly upward during arm movement, further decreasing the subacromial clearance.
Treatment Pathways Following Diagnosis
Following a positive Hawkins Test and a diagnosis of subacromial impingement, treatment typically begins with conservative, non-surgical approaches. The initial focus is on reducing pain and inflammation, often managed with rest, activity modification, and non-steroidal anti-inflammatory drugs (NSAIDs). The mainstay of recovery involves a structured physical therapy program designed to restore proper shoulder mechanics.
Physical therapy concentrates on strengthening the rotator cuff muscles, particularly those that help depress the head of the humerus, to increase the subacromial space. Exercises also target improving the stability and control of the scapula, as poor scapular movement patterns can contribute to impingement.
If symptoms persist despite consistent physical therapy and anti-inflammatory medication, the clinician may recommend a subacromial corticosteroid injection. This procedure delivers a strong anti-inflammatory medication directly into the compressed space to quickly reduce inflammation.
Should a patient remain significantly disabled after three to six months of appropriate conservative care, surgical intervention may be considered. The most common surgical procedure is arthroscopic subacromial decompression, which involves minimally invasive surgery to remove bony spurs or a small portion of the acromion to permanently widen the subacromial space.