Neer and Hawkins Kennedy impingement tests

What are the Neer and Hawkins Kennedy impingement tests?

The Neer and Hawkins-Kennedy tests are commonly used clinical tests to assess for shoulder impingement, specifically subacromial impingement.

Here’s a brief description of each test:

  1. Neer Test: The Neer test is performed with the patient standing or sitting upright. The examiner stabilizes the scapula with one hand while passively elevating the patient’s arm straight forward with the thumb pointing downward. This motion brings the greater tuberosity of the humerus into contact with the acromion and coracoacromial ligament, potentially reproducing pain. The test is considered positive if the patient experiences pain or discomfort during the elevation of the arm.
  2. Hawkins-Kennedy Test: The Hawkins-Kennedy test is also performed with the patient in a standing or sitting position. The examiner flexes the patient’s shoulder and elbow to 90 degrees each, then internally rotates the shoulder by forcibly rotating the arm inward. This maneuver brings the greater tuberosity of the humerus into contact with the coracoacromial arch. If the patient experiences pain or discomfort during this internal rotation motion, the test is considered positive.

Both tests are used to assess for impingement of the structures in the subacromial space, including the rotator cuff tendons and bursa.

A positive test result indicates that compression or impingement of these structures may be contributing to the patient’s shoulder pain.

These are provocative maneuvers that are very sensitive (80%–90%) for impingement but not very specific (30%–50%).

The Neer test causes pain when the patient’s shoulder is flexed forward maximally by the examiner, while the arm is internally rotated (palm down) and the shoulder is stabilized.

The Hawkins–Kennedy test reinforces a positive Neer impingement test. The examiner puts the shoulder into 90 degrees of forward flexion and flexes the elbow to 90 degrees. The arm is internally rotated as if the patient is emptying a can of soda in front of themselves.

Both these maneuvers compress the greater tuberosity of the humerus against the anterior acromion (Neer test) or coracoacromial ligament (Hawkins–Kennedy test) and elicit discomfort in patients who have a rotator cuff tear or impingement.

It’s important to note that these tests are just part of the clinical assessment, and the diagnosis of shoulder impingement requires a comprehensive evaluation that includes a thorough history, physical examination, and potentially additional imaging studies if needed.

A healthcare professional, such as an orthopedic specialist or physical therapist, should perform and interpret these tests in the context of the individual patient’s symptoms and clinical presentation.

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