Hawkins-Kennedy test: how to perform and interpret it
The Hawkins-Kennedy test screens for subacromial shoulder pain. Flex the patient's shoulder and elbow to 90°, then passively rotate the arm internally. It is positive when it reproduces the patient's shoulder pain. It is sensitive but not specific, so it is most useful for ruling subacromial pain out when negative.
Purpose
To compress the subacromial structures against the coracoacromial arch.
How to perform the Hawkins-Kennedy test
- Stand beside the seated or standing patient.
- Flex the shoulder to 90° with the elbow flexed to 90°.
- Support the elbow and passively rotate the shoulder internally.
- Ask whether this reproduces the patient's familiar pain.
Positive result and interpretation
Reproduction of the patient's familiar anterior or lateral shoulder pain during internal rotation.
Suggests subacromial pain such as rotator cuff tendinopathy or bursitis. It is also often positive in other painful shoulders, so a positive result alone is not diagnostic.
Cluster it with
- Painful arc
- Neer test
- Empty can / Jobe test
- External rotation resistance test
Common mistakes
- Treating a positive result as a confirmed diagnosis.
- Forcing internal rotation in a stiff shoulder - suspect frozen shoulder if passive range is globally restricted.
Frequently asked questions
What is the difference between the Hawkins-Kennedy and Neer tests?
Both provoke the subacromial space. Hawkins-Kennedy uses 90° flexion with passive internal rotation; Neer uses passive overhead elevation in internal rotation. Both are sensitive but not specific.
Is the Hawkins-Kennedy test still useful?
Yes, as a screening test. A negative result helps rule subacromial pain out, and combining it with the painful arc and resisted external rotation improves diagnostic value.