The Hawkins Kennedy test is performed by forward flexing the shoulder joint to 90 degrees and the elbow flexed 90 degrees, then forcibly internally rotate the shoulder.
What does a positive Hawkins Kennedy test mean?
Pain suggests tendinitis or calcification in the supraspinatus tendon or secondary impingement, caused by anterior acromial margin changes, for example.
In a positive impingement syndrome, impingement of the greater tubercle or compression of the supraspinatus tendon occurs, causing severe pain on motion (a positive hawkins kennedy test).
Coracoid impingement is revealed when the arm is further adducted and the supraspinatus tendon also impinges against the coracoid process.
Jobe introduced a variation of the impingement test in which the adducted arm is internally rotated, causing primarily the posterior portion of the supraspinatus tendon to become wedged under the coracoacromial arch.
Sensitivity & Specificity
Rotator cuff impingement
Rotator cuff impingement is a painful disorder which is thought to arise from repetitive compression or rubbing of the tendons (mainly supraspinatus) under the coracoacromial arch.
Normally, when the arm is abducted, the conjoint tendon slides under the coracoacromial arch.
As abduction approaches 90 degrees, there is a natural tendency to externally rotate the arm, thus allowing the rotator cuff to occupy the widest part of the subacromial space. If the arm is held persistently in abduction and then moved to and from in internal and external rotation (as in cleaning a window, painting a wall or polishing a flat surface), the rotator cuff may be compressed and irritated as it comes in contact with the anterior edge of the acromion process and the taut coracoacromial ligament.
This attitude (abduction, slight flexion and internal rotation) has been called the ‘impingement position’.
Perhaps significantly, the site of impingement is also the ‘critical area’ of diminished vascularity in the supraspinatus tendon about 1 cm proximal to its insertion into the greater tuberosity.
The development of impingement is thought to be due to intrinsic and extrinsic factors.
Intrinsic factors include:
Degeneration of the tendon,
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.
Changes in vascularity may also contribute.
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.
It can also occur in inflammatory conditions such as gout or rheumatoid arthritis.
Extrinsic factors that may cause impingement include:
spurs growing down the coracoacromial
ligament, a laterally sloping acromium,
osteoarthritic thickening of the acromioclavicular joint.
Campbel's Operative Orthopaedics 13th Book
Clinical Tests for the Musculoskeletal 3rd Ed. Book