Which test is described as seated with 90° shoulder flexion and maximal internal rotation, causing pain due to impingement?

• A. Hawkins/Kennedy
• B. Neer's Test
• C. Impingement Relief Test
• D. Dropping Sign

Answer: (A)

The test described targets subacromial impingement by compressing the structures under the coracoacromial arch when the arm is elevated and then rotated. Specifically, Hawkins-Kennedy is performed with the patient seated, the shoulder flexed to about 90 degrees, the elbow bent, and the arm passively internally rotated. This position narrows the space where the supraspinatus tendon and subacromial bursa pass beneath the acromion, so if impingement pathology is present, pain is reproduced. That’s why this exact description—seated with 90° shoulder flexion and maximal internal rotation causing impingement pain—best fits Hawkins-Kennedy.

Neer’s test also provokes impingement but uses forward flexion with gliding the scapula to isolate impingement under the acromion, not the specific 90-degree flexed position with internal rotation. The Dropping Sign (drop arm test) assesses a rotator cuff tear when the patient suddenly drops the arm from ~90 degrees of abduction, rather than provoking impingement with internal rotation. The Impingement Relief Test is a different maneuver used in some clinical paradigms and isn’t the standard description for this particular 90-degree flexion with internal rotation pattern.