Hawkins Kennedy Test | Supraspinatus Tendon Test

Hawkins Kennedy Test is a frequently applied orthopedic examination which is aimed at testing the impingement of the supraspinatus tendon and other muscles of the shoulder joint. This shoulder impingement test was developed about 1980 by the orthopedic surgeon Dr. R. Hawkins and Dr. J. Kennedy. It is used as part of the evaluation of shoulder impingement, specifically the supraspinatus tendon, and is a part of any clinician’s shoulder examination.

Indications for the Hawkins-Kennedy Test:

• Pain in the shoulder especially when participating in overhead activities.
• Suspected impingement syndrome.
• Inability to perform the auto-locked resisted shoulder abduction or forward flexion without pain.
• Assessment of rotator cuff disorders.

How to Perform the Hawkins-Kennedy Test:

1. Patient Position: The patient should be seated or standing with their arm relaxed at their side. Clinician Position: The clinician stands beside the patient, facing them. 
2. Arm Positioning: The clinician flexes the patient’s shoulder to 90 degrees, ensuring the arm is parallel to the ground. The elbow is flexed to 90 degrees, with the forearm pointing forward. 
3. Test: The clinician supports the patient’s elbow with one hand while holding the wrist with the other hand. The clinician then internally rotates the patient's shoulder by pushing down on the wrist while supporting the elbow. This action brings the greater tuberosity of the humerus into contact with the undersurface of the acromion or the coracoacromial ligament.

Assessment Outcome of Hawkins-Kennedy Test :

• Positive Test: Discomfort while internally rotating the shoulder signifies impingement portending possible pathology of the supraspinatus tendon or the other structures of the shoulder in question.
• Negative Test: I would expect that if there is no pain during the maneuver, then there is less possibility of impingement.

Differential Diagnosis with Hawkins-Kennedy Test:

• Subacromial Impingement Syndrome (SIS): A positive Hawkins-Kennedy Test is highly suggestive of SIS, especially involving the supraspinatus tendon.
•  Rotator Cuff Tendinopathy: Pain in this test might also indicate rotator cuff tendinopathy, particularly in the supraspinatus tendon, as it can be impinged under the acromion. 
• Bursitis: Subacromial bursitis may also cause a positive Hawkins-Kennedy Test due to inflammation of the bursa beneath the acromion.

Other Related Tests for Shoulder Impingement:

• Neer Test: Another test for shoulder impingement that is conducted after the patient stands with the affected arm at the side and internally rotates the shoulder by bringing the straightened fingers towards the back while the examiner gently flexes the shoulder.
• Empty Can Test (Jobe Test): Tenders to test the strength of supraspinatus muscle and does provoke pain in conditions such as impingement.

Evidence-Based Physiotherapy Research:

Recent research in physiotherapy supports a multimodal approach to managing shoulder impingement, including:

• Exercise Therapy: Therapies aimed at improving the forces and control of the rotator cuff and scapula muscles.
• Manual Therapy: Technique used in mobilization and manipulation of movable adversely affected joints.
• Education and Activity Modification: Treatment for posture and ergonomics involved in impingement issues.
• Modalities: When combined with exercise therapy, such treatments as ultrasound or electrotherapy can be used.

Research proves that programmes involving specific rotator cuff and scapular strengthening enhances education besides manual therapy in managing pain and increasing functional capacity in patients with shoulder impingement syndrome.

In conclusion, Hawkins-Kennedy Test is a helpful tool in the practicing physiotherapist’s armamentarium to diagnose shoulder impingement, determine treatment and enhance the chances of a favorable outcome for the patient while utilizing research based-on evidence.