Anatomical validity of the Hawkins-Kennedy test--a pilot study

Purpose: Despite routine use, clinical tests used to diagnose subacromial impingement often display poor diagnostic accuracy. A lack of anatomical validity may contribute to the poor diagnostic accuracy. The current study aimed to examine the anatomical validity of measuring subacromial pressure in the Hawkins-Kennedy impingement test in a cadaveric shoulder.

Methods: Subacromial pressures were measured using pressure transducers in non-provocative and provocative Hawkins-Kennedy test positions using an ABA research design with 25 repeated measures in one cadaver. Data collected included pressure at four subacromial locations (coracoid process, coraco-acromial ligament, anterior acromion and posterior acromion), and observation of anatomical structures impinging on transducers. The split-middle method of visual analysis and the Reliable Change Index (RCI) were applied to examine any differences between provocative and non-provocative positions.

Results: There was increased pressure in the provocative position at the coraco-acromial ligament, which impinged biceps brachii, and at the anterior acromion, which impinged the rotator interval.

Conclusion: Findings of the current study provide evidence that suggest that structures other than the rotator cuff tendons may be impinged during the Hawkins-Kennedy test.