Hawkins Kennedy test

 Hawkins Kennedy test

What is Hawkins Kennedy test?

Hawkins Kennedy test (Hawkins test) is used for impingement syndrome of the rotator cuff of the shoulder, it was first introduced by Canadian Drs. R. Hawkins and J. Kennedy in the 1980s.

See Also: Rotator Cuff of the Shoulder

How do you perform the Hawkins Kennedy test?

Hawkins Kennedy test
Hawkins Kennedy test

What does a positive Hawkins Kennedy test mean?

Sensitivity & Specificity

A systematic review with meta-analysis of individual tests by Eric J Hegedus 1 found that the Hawkins Kennedy test has the following accuracy:

Another systematic review and meta-analysis study by Sigmund Gismervik 2 found that Hawkins Kennedy test has a Sensitivity of 58 %, and a Specificity of 67 %.

McDonald et al.3 assessed the diagnostic accuracy of the Neer and Hawkins test for the diagnosis of subacromial bursitis or rotator cuff pathology in 85 consecutive patients undergoing shoulder arthroscopy by a single surgeon.

The Neer sign was found to have a sensitivity of 75% for the appearance suggestive of subacromial bursitis; this compared with 92% for the Hawkins test. For rotator cuff tearing, the sensitivity of the Neer sign was 85% and that of the Hawkins sign was 88%. Specificity and positive predictive values for the two tests were low, being not much higher than pretest probability. The two tests had a high negative predictive value (96% for bursitis, 90% for rotator cuff tearing) when they were combined.

Notes

Rotator Cuff Impingement

The development of impingement is thought to be due to intrinsic and extrinsic factors.

Intrinsic factors include:

  1. Degeneration of the tendon.
  2. Changes in the presence of highly sulphated glycosaminoglycans and changes in the collagen composition with loading. Tendon degeneration may be age-related and a cell-mediated response.
  3. Changes in vascularity may also contribute.
  4. It is thought that these intrinsic changes result in rotator cuff dysfunction resulting in upward displacement of the humeral head and the subsequent development of extrinsic compression.
  5. It can also occur in inflammatory conditions such as gout or rheumatoid arthritis.

Extrinsic factors that may cause impingement include:

  1. Spurs growing down the coracoacromial
  2. Ligament, a laterally sloping acromion.
  3. Osteoarthritic thickening of the acromioclavicular joint.

References

  1. Eric J Hegedus, Adam P Goode, Chad E Cook, Lori Michener, Cortney A Myer, Daniel M Myer, Alexis A Wright. Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med. 2012 Nov;46(14):964-78. doi: 10.1136/bjsports-2012-091066. Epub 2012 Jul 7. PMID: 22773322.
  2. Sigmund Gismervik, Jon O Drogset, Fredrik Granviken, Magne Rø, Gunnar Leivseth. Physical examination tests of the shoulder: a systematic review and meta-analysis of diagnostic test performance. BMC Musculoskelet Disord. 2017 Jan 25;18(1):41. doi: 10.1186/s12891-017-1400-0. PMID: 28122541.
  3. MacDonald PB, Clark P, Sutherland K: An analysis of the diagnostic accuracy of the Hawkins and Neer subacromial impingement signs. J Shoulder Elbow Surg 9:299–301, 2000.
  4. Boublik M, Hawkins RJ: Clinical examination of the shoulder complex. J Orthop Sports Phys Ther 18:379–385, 1993
  5. Clinical Tests for the Musculoskeletal System 3rd Edition.
  6. Mark Dutton, Pt . Dutton’s Orthopaedic Examination, Evaluation, And Intervention, 3rd Edition Book.
  7. Millers Review of Orthopaedics, 7th Edition Book.
  8. Campbel’s Operative Orthopaedics 13th edition book.

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