The Hawkins test (also called the Hawkins-Kennedy test) is a physical examination maneuver used to check for shoulder impingement, a condition where soft tissues in the shoulder get pinched during arm movement. It’s one of the two most commonly used clinical tests for shoulder impingement, alongside the Neer test, and takes only a few seconds to perform in a doctor’s office.
How the Test Is Performed
During the Hawkins test, you’ll be seated or standing while the examiner lifts your arm forward to shoulder height with your elbow bent at 90 degrees. Your arm should be relaxed, with the examiner supporting it at the elbow. From this position, the examiner rotates your forearm downward (internally rotating the shoulder) while also moving the arm slightly across your body.
This specific combination of movements narrows the space beneath the bony arch at the top of your shoulder, pressing the rotator cuff tendons, the fluid-filled cushion (bursa) above them, and the biceps tendon against the ligaments and bone overhead. If this compression reproduces your pain, the test is considered positive.
What the Test Detects
The Hawkins test is designed to identify subacromial impingement syndrome, which is the broad term for irritation or damage to the structures that sit in the tight space beneath the top of the shoulder blade. This includes inflammation of the bursa (bursitis), partial rotator cuff tears, and full-thickness rotator cuff tears.
Anatomical studies have shown that during the test’s internal rotation movement, the highest pressures occur at the ligament that bridges the top of the shoulder, compressing the biceps tendon and the front portion of the rotator cuff against it. The subscapularis tendon, which sits at the front of the rotator cuff, also gets compressed against a bony projection called the coracoid process.
What a Positive Result Means
A positive Hawkins test means you felt pain during the maneuver, which suggests something in that subacromial space is being pinched or irritated. However, a positive result alone doesn’t confirm a specific diagnosis. The test has a sensitivity of roughly 74 to 79%, meaning it correctly flags impingement in about three out of four people who actually have it. Its specificity is lower, around 57 to 59%, which means a fair number of people without true subacromial impingement will also test positive.
Several other shoulder problems can trigger pain during the test and produce a false positive. These include arthritis of the joint where the collarbone meets the shoulder blade, tears of the cartilage rim (labrum) inside the shoulder socket, and a less common condition called internal impingement, where the undersurface of the rotator cuff gets pinched against the back of the socket during certain movements. Damage to the biceps tendon or its surrounding structures can also cause pain during the maneuver.
What a Negative Result Tells You
A negative Hawkins test, where you feel no pain during the movement, is actually more informative than a positive one. A large pooled analysis of clinical studies found that a negative result is powerful enough to help rule out subacromial impingement. When combined with a negative Neer test, the two together have a negative predictive value of 96% for bursitis and 90% for rotator cuff tearing. In practical terms, if both tests are pain-free, there’s a very high chance your shoulder pain is coming from something other than impingement.
How It Compares to the Neer Test
The Neer test is the other standard impingement maneuver. Instead of rotating the arm inward, the examiner lifts your straightened arm forward and overhead while stabilizing the shoulder blade. This compresses the same general area but from a slightly different angle. For detecting bursitis specifically, the Hawkins test is more sensitive (92%) than the Neer test (75%). For rotator cuff tears, the two are closer: 88% for the Hawkins and 85% for the Neer.
Neither test is specific enough to be used as a standalone diagnostic tool. Both are better at catching problems than at confirming exactly what the problem is.
Why Clinicians Use Multiple Tests Together
Because of the Hawkins test’s limited specificity, clinicians rarely rely on it in isolation. Research has shown that combining it with other maneuvers significantly improves diagnostic accuracy. The strongest combination for detecting any degree of impingement syndrome pairs the Hawkins test with the painful arc sign (pain when raising your arm between roughly 60 and 120 degrees) and a strength test for the infraspinatus muscle (the rotator cuff muscle responsible for external rotation). Together, these three tests yield a 95% post-test probability of impingement.
For full-thickness rotator cuff tears specifically, a different combination works best: the painful arc sign, the drop-arm test (inability to slowly lower the arm from overhead), and the infraspinatus strength test, which together produce a 91% probability. The takeaway is that the Hawkins test is one piece of a clinical puzzle. It’s a useful screening tool, particularly for ruling out impingement when negative, but confirming a diagnosis typically requires additional physical tests and often imaging.