Shoulder Orthopaedic Test: Hawkins / Kennedy Impingement Test

The Hawkins-Kennedy Test assesses shoulder pain response during passive shoulder flexion and internal rotation. It is often used in subacromial pain and rotator cuff-related shoulder pain assessment, but it does not identify one specific compressed structure. A 2024 systematic review found the evidence base for shoulder physical examination tests is large but generally low quality, so single-test interpretation should be cautious.  

Introduction

A client reports shoulder pain when reaching across the body, lifting overhead or moving into internally rotated positions. The Hawkins-Kennedy Test may reproduce familiar shoulder pain by placing the shoulder into a provocative position.

The test should not be explained as “pinching the tendon” or diagnosing impingement. A better interpretation is that it documents whether a specific shoulder position reproduces familiar pain.

Quick Summary

Test name: Hawkins-Kennedy Test
Body region: Shoulder, subacromial region, rotator cuff-related shoulder pain context
Purpose: Assess shoulder pain response to passive flexion and internal rotation
Positive finding: Reproduction of familiar shoulder pain
Negative finding: No familiar pain during the manoeuvre
Best used with: Neer’s Test, Painful Arc, Empty Can, Full Can, shoulder ROM, strength testing and functional loading
Key limitation: It does not identify the exact painful structure or diagnose impingement on its own

What Is the Hawkins-Kennedy Test?

The Hawkins-Kennedy Test is a shoulder pain provocation test. The shoulder is flexed to approximately 90 degrees, the elbow is flexed and the arm is passively internally rotated.

The test is considered meaningful when it reproduces the client’s familiar shoulder pain.

Why It Is Used

The test is used when shoulder pain is provoked by elevation, internal rotation or reaching positions.

It may help document pain behaviour and guide further assessment of ROM, strength, load tolerance and functional movement.

What It Assesses

The test assesses pain response to a specific shoulder position. It does not isolate the rotator cuff, bursa, labrum, capsule or acromion.

Who It Is Useful For

This test may be useful for clients with shoulder pain during reaching, lifting, overhead activity, gym movements, swimming, throwing or work tasks.

When to Use This Test

Use when passive shoulder flexion and internal rotation can be performed safely and the clinical question involves shoulder pain provocation.

When Not to Use or When to Be Cautious

Use caution with acute trauma, severe pain, recent surgery, instability, suspected fracture, high irritability or inability to tolerate passive shoulder movement.

Equipment Required

Chair or treatment table
Pain and symptom scale
Measurz recording workflow
Optional comparison side notes

Step-by-Step Protocol / Practice

Setup

Position the client sitting or standing.

Client position

The client relaxes the tested arm.

Examiner position

Stand beside or in front of the client.

Hand placement

Support the elbow and wrist or forearm.

Stabilisation

Control the scapula and trunk as needed.

Movement or force direction

Flex the shoulder to around 90 degrees with the elbow flexed, then gently internally rotate the shoulder.

Instructions

Ask the client to report pain location, intensity, quality and whether symptoms are familiar.

Positive finding

A positive finding is reproduction of familiar shoulder pain.

Negative finding

A negative finding is no familiar shoulder pain during the manoeuvre.

Stopping criteria

Stop if pain increases sharply, guarding occurs or the position is not tolerated.

Safety notes

Do not force internal rotation. Record symptom location and whether it matches the client’s usual pain.

Positive and Negative Test Interpretation

A positive Hawkins-Kennedy Test may support shoulder pain provocation reasoning when it reproduces familiar symptoms.

It does not prove structural impingement or identify the tissue source. Pain may relate to rotator cuff-related shoulder pain, bursal sensitivity, joint sensitivity, stiffness, load intolerance or other shoulder contributors.

A negative test does not exclude rotator cuff-related shoulder pain or subacromial pain, especially if symptoms occur only under load or fatigue.

Sensitivity, Specificity and Diagnostic Accuracy

The Hawkins-Kennedy Test is used to assess possible subacromial pain or impingement-related symptoms. Research suggests it has moderate diagnostic accuracy, meaning a positive test may support suspicion of subacromial involvement, but it does not confirm it by itself. It is best interpreted alongside other shoulder tests, range of motion, strength testing, and client history.

Reported diagnostic values include:

• Sensitivity: 58%
• Specificity: 67%

Reliability and Validity

Reliability depends on consistent shoulder flexion angle, internal rotation range, force, symptom criteria and comparison side.

The 2020 JOSPT viewpoint on rotator cuff-related shoulder pain also cautioned against using special tests to identify precise tissue sources.  

Common Errors and Limitations

Common errors include forcing internal rotation, treating any discomfort as positive, using the test to diagnose impingement, failing to record symptom location and not pairing with strength or functional findings.

Limitations include poor tissue specificity, symptom overlap, variable force, pain irritability, stiffness and limited single-test certainty.

Practical Applications

Use the Hawkins-Kennedy Test to document whether passive flexion and internal rotation reproduce familiar shoulder pain. It is most useful when combined with ROM, strength, painful arc and functional loading.

How to Record This in Measurz

Record test name, side tested, result, pain score, symptom location, symptom quality, shoulder flexion angle, internal rotation tolerance, comparison side, guarding, compensation, confidence in result and reason for stopping.

Add related findings such as Neer’s, Painful Arc, Empty Can, Full Can, shoulder ROM, external rotation strength and overhead task symptoms.

Related Tests / Internal Links

Neer’s Test
Painful Arc
Empty Can Test
Full Can Test
Infraspinatus Test
Shoulder ROM Tests
Shoulder Strength Testing
Scapular Assessment

FAQs

What does the Hawkins-Kennedy Test assess?

It assesses whether passive shoulder flexion and internal rotation reproduce familiar shoulder pain.

What is a positive Hawkins-Kennedy Test?

A positive finding is reproduction of the client’s familiar shoulder pain.

Does it diagnose shoulder impingement?

No. It may support shoulder pain provocation reasoning but does not diagnose impingement on its own.

Should the test be forced?

No. Internal rotation should be controlled and stopped if symptoms escalate.

What should be recorded?

Record side, pain score, symptom location, shoulder position, internal rotation tolerance and comparison side.

Key Takeaways

The Hawkins-Kennedy Test is a shoulder pain provocation test.
It does not identify one compressed structure.
Familiar symptom reproduction matters more than general discomfort.
Use it with ROM, strength and functional findings.
Measurz should capture pain location, position and test tolerance.

References

Gismervik, S. Ø., Drogset, J. O., Granviken, F., Rø, M., & Leivseth, G. (2017). Physical examination tests of the shoulder: A systematic review and meta-analysis of diagnostic test performance. BMC Musculoskeletal Disorders, 18, 41.

Powell, J. K., & Lewis, J. S. (2020). It is time to put special tests for rotator cuff-related shoulder pain out to pasture. Journal of Orthopaedic & Sports Physical Therapy, 50(5), 222–225.

Zhang, A. L., et al. (2024). Evidence-based approach to the shoulder examination for subacromial bursitis and rotator cuff tears: A systematic review and meta-analysis. BMC Musculoskeletal Disorders, 25, Article 911.