How to Use the Hawkins-Kennedy Test in Shoulder Evaluation

The Hawkins-Kennedy test, often shortened to the Hawkins test, is a widely used orthopedic screening tool that helps identify signs of shoulder impingement—particularly involving the supraspinatus tendon or subacromial bursa. For occupational therapists working with clients experiencing shoulder pain, recognizing impingement early can inform targeted treatment and help prevent prolonged dysfunction.

This article outlines what the Hawkins-Kennedy test is, how and when to apply it, and how it fits within a broader shoulder evaluation. We’ll also review test accuracy, clinical interpretation, and an example scenario for context.

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What Is the Hawkins-Kennedy Test?

The Hawkins-Kennedy test is a passive shoulder movement test that provokes symptoms of subacromial impingement. It was first described by orthopedic surgeons Dr. R.J. Hawkins and Dr. J.C. Kennedy in 1980 and remains a staple in shoulder assessments for occupational therapy, physical therapy, and sports medicine.

How the Test Works

The client’s shoulder is brought into 90 degrees of forward flexion with the elbow bent at 90 degrees. The examiner then applies passive internal rotation of the humerus, compressing the subacromial space between the greater tuberosity and the coracoacromial arch. Pain produced during this motion indicates a positive Hawkins-Kennedy test.

When and Why Occupational Therapists Use the Hawkins-Kennedy Test

Occupational therapists frequently use the Hawkins-Kennedy impingement test during upper extremity evaluations. It is particularly useful for clients reporting pain during overhead activities—such as reaching into cabinets, dressing, or grooming. These tasks often aggravate impingement symptoms, and the Hawkins-Kennedy test helps clarify the source of pain.

Use of the test can:

• Suggest mechanical compression in the subacromial space

• Rule in impingement-related conditions when combined with other tests

• Support clinical decision-making regarding activity modification and rehabilitation strategies

Though the test alone cannot confirm a diagnosis, it contributes valuable information when combined with patient history, functional screening, and palpation.

Accuracy and Interpretation of the Hawkins-Kennedy Test

The Hawkins-Kennedy test has been found to have moderate sensitivity (58% to 92%) and lower specificity (25% to 66%) when used to detect subacromial impingement¹. This means it can help identify clients who may have impingement-related pain but should not be used in isolation to determine pathology.

A positive test typically elicits anterior or lateral shoulder pain. Because the maneuver compresses multiple soft tissues—including the supraspinatus tendon and subacromial bursa—pain may be caused by bursitis, rotator cuff tendinopathy, or other non-specific irritation in the space.

As always, red flags or non-mechanical pain patterns should prompt further evaluation or referral.

Performing the Hawkins-Kennedy Test: Step-by-Step

1. Position the client: Seated or standing with the arm relaxed.

2. Flex the shoulder: Passively raise the arm to 90 degrees of shoulder flexion with 90 degrees of elbow flexion.

3. Apply internal rotation: While supporting the elbow and wrist, rotate the humerus internally by moving the wrist downward.

4. Observe response: A positive test is marked by pain or discomfort in the anterior or lateral shoulder.

The Hawkins-Kennedy test is quick to administer and can be easily integrated into a standard shoulder screen alongside active range of motion, strength testing, and functional movement observation.

Example: Using the Hawkins-Kennedy Test in Practice

A 55-year-old client presents with shoulder pain that worsens during household tasks, especially reaching overhead or behind the back. They report difficulty putting on shirts and styling their hair.

You begin with a musculoskeletal assessment, including active motion and palpation, and observe limited elevation and tenderness in the anterior shoulder. You perform the Hawkins-Kennedy test, and the client immediately reports pain with internal rotation at 90 degrees flexion.

You record a positive Hawkins-Kennedy sign, which—when combined with a painful arc and Neer’s sign—supports the likelihood of subacromial impingement. You proceed with a treatment plan focused on postural alignment, scapular stability, and patient education.

Pairing the Hawkins-Kennedy Test with Other Shoulder Exams

To improve diagnostic accuracy, the Hawkins-Kennedy test should be used with other special tests. Common complementary assessments include:

• Neer’s Test – evaluates impingement through passive flexion of the arm

• Painful Arc Test – identifies pain during active shoulder elevation between 60°–120°³

• Empty Can Test – targets supraspinatus muscle integrity and provocation of symptoms⁴

A combination of tests offers more diagnostic value than any one test alone. A 2013 systematic review noted that combining the Hawkins-Kennedy test with other physical exams improves predictive value when identifying rotator cuff disease⁵.

Other Special Tests to Use with Hawkins

Because no single orthopedic test can definitively diagnose impingement syndrome, it’s best to use a group of assessments to build clinical confidence. These often include:

• Neer’s Test – passive forward flexion with internal rotation to compress subacromial structures

• Painful Arc Test – active shoulder elevation that produces pain between 60–120 degrees³

• Empty Can Test – assesses supraspinatus strength and irritation⁴

Combining multiple tests improves diagnostic accuracy. A meta-analysis published in Physical Therapy in Sport found that combining the Hawkins, Neer, and painful arc tests offered a higher predictive value than any individual test⁵.

The Hawkins-Kennedy test is a valuable component of the occupational therapist’s shoulder assessment toolkit. When applied thoughtfully, it can help identify movement-related pain stemming from subacromial impingement and guide intervention strategies.

By understanding when to use the Hawkins-Kennedy test—and how to interpret it in context—occupational therapists can make more informed clinical decisions and improve outcomes for clients dealing with shoulder dysfunction.

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References

1. Hegedus EJ, Cook C, Brennan M, et al. Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. Br J Sports Med. 2008;42(2):80–92. https://bjsm.bmj.com/content/42/2/80

2. Calis M, Akgun K, Birtane M, Karacan I. Diagnostic values of clinical diagnostic tests in subacromial impingement syndrome. Ann Rheum Dis. 2000;59(1):44–47. https://ard.bmj.com/content/59/1/44

3. Park HB, Yokota A, Gill HS, El Rassi G, McFarland EG. Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg Am. 2005;87(7):1446-1455. https://journals.lww.com/jbjsjournal/Abstract/2005/07000/

4. Hermans J, Luime JJ, Meuffels DE, Reijman M, Simel DL, Bierma-Zeinstra SM. Does this patient with shoulder pain have rotator cuff disease? The Rational Clinical Examination systematic review. JAMA. 2013;310(8):837-847. https://jamanetwork.com/journals/jama/article-abstract/1733723