Execution
- 1Position the patient standing or sitting.
- 2Forward flexes the shoulder to 90°.
- 3Flex the elbow and support the patient’s arm so the patient can relax.
- 4Forcibly internally rotate the proximal humerus.
- 5Repeat the manoeuvre at slightly different degrees of forward flexion or horizontal adduction if the symptom location needs clarification.
Positive outcome
Pain during forced internal rotation is positive. Magee describes this as compression of the supraspinatus tendon against the anterior coracoacromial ligament / coracoid region and interpret pain as supraspinatus paratenonitis / tendinosis or secondary impingement. A coracoid-localised response during extra horizontal adduction may indicate coracoid impingement rather than classic subacromial pain.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Michener et al. (2009) | NA | 63 | 62 | 1.63 | 0.60 |
| Hegedus et al. (2012) | NA | 79 | 59 | 1.93 | 0.36 |
| Alqunaee et al. (2012) | NA | 74 | 57 | 1.70 | 0.46 |
CommentHawkins-Kennedy is sensitive enough to be useful as part of a SAPS screen but too nonspecific to diagnose SAPS alone. Magee notes that modified positioning can help distinguish pinching from muscle strain, but the manoeuvre still compresses several possible pain generators. The test becomes more useful when combined with painful arc and resisted external rotation / infraspinatus testing.
Low Clinical Value