Which test is used to provoke shoulder impingement by elevating the arm to 90 degrees with internal rotation?

• A. Neer
• B. Empty can
• C. O'Brien's
• D. Hawkins-Kennedy

Answer: (D)

Hawkins-Kennedy explicitly targets subacromial impingement by placing the arm in a position that narrows the subacromial space and then internally rotating. With the shoulder raised about 90 degrees and the elbow flexed, internal rotation drives the greater tubercle under the coracoacromial arch, compressing the rotator cuff tendons (especially the supraspinatus) and the subacromial bursa against the acromion. If this impingement is present, this maneuver reproduces pain, supporting a subacromial impingement diagnosis. Other tests approach impingement differently or assess other structures (for example, Neer also provokes impingement via flexion, but the Hawkins-Kennedy combination of 90-degree elevation with internal rotation is the classic setup for this specific impingement provocation).