Execution
- 1Perform the Hawkins-Kennedy test and marks it positive if familiar subacromial / anterior shoulder pain is reproduced.
- 2Perform the painful arc sign and marks it positive if familiar pain occurs during the mid-range of active elevation.
- 3Perform resisted external rotation or infraspinatus muscle testing and marks it positive if familiar pain or meaningful weakness is present.
- 4Count the number of positive findings.
- 5Interpret all three positive findings as a strong rule-in cluster; two of three positive findings increases suspicion but less strongly.
Positive outcome
The strongest SAPS cluster is positive when Hawkins-Kennedy, painful arc, and infraspinatus / resisted external rotation testing are all positive. Two of the three positive findings still increases the probability of SAPS, but not to the same degree. A separate Michener cluster uses three or more positives from Neer, Hawkins-Kennedy, painful arc, empty can, and external rotation resistance.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Park et al. (2005) | NA | NA | NA | 10.56 | 0.17 |
| Michener et al. (2009) | NA | 75 | 74 | 2.93 | 0.34 |
| Hegedus et al. (2015) | NA | NA | NA | 10.56 | 0.17 |
CommentThis is the highest-value SAPS entry because the Park cluster combines provocation, active arc behaviour, and cuff-resistance response. Methodological caveat: the high LR+ belongs to the three-test cluster, not to any individual impingement sign, and the exact reference standard and case mix influence post-test probability. Michener’s five-test cluster is more modest but clinically useful because it includes the same SAPS-style provocation signs used in routine shoulder assessment.
High Clinical Value