Name: Shoulder Special Test: Hawkins-Kennedy and Yocum's Tests
Uploaded: 2023-04-26T01:01:30.000Z
Duration: 13 min 40 s
Description: Learn to properly perform and evaluate the Hawkins-Kennedy and Yocum's Shoulder Special Tests. This tutorial provides a step-by-step approach, including indications, contradiction, and modifications.

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https://stream.mux.com/Xp8rVEKmsYkmVH02RInhyPPCd0200Vp00cWHJ2tlcpAlbWs.m3u8

Learn to properly perform and evaluate the Hawkins-Kennedy and Yocum's Shoulder Special Tests. This tutorial provides a step-by-step approach, including indications, contradiction, and modifications.

Introduction to Shoulder Impingement Tests

Demonstrating Hawkins Kennedy Test

Challenges in Performing the Hawkins Kennedy Test

Introducing the Yocum Test

Mechanics of Shoulder Impingement Tests

Understanding Sensitivity and Specificity in Impingement Tests

Importance of Concordant Signs in Diagnosis

Conclusion and Key Takeaways on Shoulder Tests

Shoulder Special Test: Hawkins-Kennedy and Yocum's Tests

This is Brent of the Brookbush Institute and in this video we're going over the Hawkins Kennedy and Yocum's Tests. These are tests for shoulder impingement, some shoulder pain and dysfunction, during our physical exam for individuals who are complaining of shoulder pain. I'm going to have my friend Melissa come out, she's going to help me demonstrate. The Hawkins Kennedy is basically forced internal rotation at 90 degrees of flexion. The way we're going to make that happen is, I'm going to have Melissa start at 90 degrees of flexion, I'm going to lumbrical grip, or lobster grip, her humerus and forearm like so. I'm on her forearm, but it's as close to her elbow as I can be. That gives me control of elbow flexion and extension, as well as internal and external rotation. I then have this hand to stabilize the scapula so that this doesn't become a scapular upward rotation test. Then I'm going to put that palm down, like I have in a few other videos, so that I have control of her thorax. I don't want to push her off of the table. We know that's a bad thing! If you push somebody off a table, they're not coming back and you're not going to fix anything. You might break something else actually, now that I think about that! You're going to stabilize the scapula, and get this nice grip. Notice, my elbows are nice and high, so everything's in line for me. I can compress a little bit, which is going to help my control. I can then look at Melissa's face, so I can see when I do this test if she gets a little grimace. That's going to help me decide whether that was a positive test. I'm going to force her into internal rotation, somewhat vigorously, and I'm going to ask her, "was that the symptom you were talking about?". -No. That would be a negative Hawkins Kennedy. Keep in mind, I've seen different things on the speed of this test. I think the best thing to do is use your heads when it comes to how fast you do this, and consider, what was their subjective examination like? Is Melissa a pitcher, who is only complaining about shoulder pain when she's throwing as fast as she possibly can? Or, is she somebody who just walked in and said, "look I had a fall about three weeks ago, my shoulders gotten progressively worse, and now if I push open a door, I can feel a lot of pain". Obviously, for the latter, just doing this might be enough. If we're talking about a pitcher whose only feeling pain during high- level activity, I might have to be a little bit more vigorous to get that positive sign. I might take note of that to ensure when I come back to this, or maybe another therapist follows up, they don't go, "oh they're fine". We want to make sure that we replicate what they're doing in their lives. Now, I'm  just going to show you guys a couple other views, because I know this is a little bit difficult to see if I face you. You can see this hand, palm down, arm high, so I can control her thorax, and elbow high with lobster grip. If I come back this way, it's same thing. You can see here, here, and, I could even come down here with my forearm, and stabilize her thoracic spine if I got the table up a little higher. I'm here, my elbow is nice and high, I internally rotate, then, "was that the symptoms you were talking about?". -Yes. She's positive on her right side, negative on her left side. We do have one problem with this exam, I don't know if you've already seen it, but I happen to have large hands which makes this an easy test for me to do. I'm usually a bit larger than my patients, so this lobster grip for me, this lumbrical grip is actually what it's called, is easy. If we flip this around, and Melissa was my therapist, I'm not so sure she'd have as easy of a time controlling my arms with this grip, or if she was an even smaller practitioner, on an even larger client. Let's say you're a female ATC working on the football team at your college program, this is going to be a tough one to pull off. I have seen this test performed this way, holding an elbow and holding a wrist, just be careful if you're going to do internal rotation this way that you're watching the AC joint and it's not elevating as you go. If I do that on this side, we don't want to see this. We want to make sure that that internal rotation is right in line with where you started. You're going to have to learn how to use this elbow to do that, and also keep in the back of your mind that that may decrease the sensitivity of this test. What seems to be a spin-off of the Hawkins Kennedy, with a little less documentation on standard directions, a little less in the research department, in fact, I really couldn't find any research determining specificity and sensitivity for, is the Yocum exam. It's basically a spin-off of the Hawkins Kennedy. You're going to put one hand on the opposite shoulder, then raise the elbow. You can see here, where it's still flexion and internal rotation, they've just stabilized the hand, almost making it closed-chain. I think it may have started as an attempt to test yourself. If you have people do this they're going to compensate. There's too much open, there are too many ways to work around whatever your painful range is. With this, I've even seen it attempted to be sensitised a little bit by having somebody push into this shoulder, so now you have horizontal adduction, flexion with internal rotation, which from an impingement standpoint, is definitely going to be a little bit more provocative. I have seen it done self-administered this way. I've seen it done where the therapist passively lifts into elbow flexion. Again, not so much research on this. That's something for you to think about. It may be something that can be used in more of a group setting, as a clearing or screen. It also might be something that, once again, my smaller practitioners, can do on much larger patients. What is the intent of this test? Let's talk about anatomy here really quickly. With all of these impingement tests, we're trying to clamp down on the subacromial space. Basically, think of how impingement means pinching. That's what it means, so we're trying to pinch down on things like the long head of the biceps tendon. We're trying to brush up against the acromioclavicular ligament. We're trying to pinch down on the subacromial bursa. We're trying to irritate the superior capsule, which has been inflamed in part of this person's condition. If I take her arm up this way, ideally, in a person who had good shoulder function, when we did internal rotation, they'd have superior roll, and inferior glide. But, if I'm stabilizing and holding everything down, and I push them into internal rotation, chances are we're going to have superior roll, which is going to take that humeral head and just roll it right up into the inferior part of the acromion, as well as that acromioclavicular ligament. So, just like all of our shoulder impingement tests, we're smashing the subacromial space. If we smash the subacromial space and we get pain, that's actually abnormal. If these tissues were not already inflamed, if they were not already irritated, something like that shouldn't hurt. It may not be comfortable, but it shouldn't hurt or provoke symptoms. Where does this fall when it comes to specificity/sensitivity? How am I going to use this? This test is definitely more sensitive than the near test. Like we talked about, the Neer test isn't the greatest test out there. However, it's less sensitive than the supine impingement test. So, why am i showing it to you? The Hawkins Kennedy shows up in these clusters that we're going to use to get high sensitivity and specificity, whereas the supine impingement test does not. Now, we do have to mention that the specificity of the Hawkins Kennedy, and presumably the Yocum, is very low, like all of our impingement tests. You can imagine the specificity is low because, if you have shoulder dysfunction, whether it's a labral tear, biceps tendinitis, subacromial bursitis, or capsulitis, this is not going to feel good. So, this test ends up capturing a lot of things, and not being very specific to impingement by itself. In fact, there's been research on the Hawkins Kennedy about how sensitive it is to rotator cuff tears, and how sensitive it is to superior labral tears. You've got to keep this in mind as you're building up your hypothesis going through your assessment; if Melissa came in and her subjective was, once again, gradual onset, maybe only pain during really high-end physical activity. If I've done my movement assessment with her, and my overhead squat assessment, and she had scapular elevation and I see a little bit of kyphotic posture - notice she's a little internally rotated. She sits like this a lot, because when she's not pitching... as we totally make up a college career for you... when she's not pitching, she's sitting there studying. These things are starting to build a case for impingement. Gradual onset pain, only at the highest level of activity, maybe a little soreness after high-end activity. I'm starting to see some postural dysfunction that makes her movement not great. I'm starting to work towards my clusters here. Maybe I did the Neer, and got a positive, and add the Hawkins Kennedy, and got a positive, and then I did a few more tests for impingement and they all came back positive. Then, on top of it, when I tried to test for some other stuff - labral tears, rotator cuff tears, those all came back negative. So now, even though I had low specificity on this test, I'm starting to gain some specificity due to negatives on other tests. Now I'm starting to build this strong case of impingement. This is her concordant sign, and it's getting better with treatment for impingement syndrome. Now I pretty much know I'm on the right track. Always keep in mind this test and the concordant sign. This, as the test that you're going to use pre and post, is what you're always looking for. No matter what test you're going through or how many tests you use, always put a little asterisk by the one test that you can keep coming back to after every intervention if you want to see if that's going to specifically help the individual. Of course, keep in mind, since all of these tests for shoulder impingement have low specificity, if you do some treatments and you're not effective, and you're a confident experienced therapist, it might be time to refer out. There's low specificity here. Even though everything might point to shoulder impingement, maybe she did have a rotator cuff tear, and me continuing to crank on this rotator cuff tear without further diagnostic imaging to tell me, "you should probably back off of this or that" is not a great idea. I might need to send her back to her physician to get some imaging. Or, maybe this is an impingement that's out of control, and we need anti-inflammatories, or a shot or something like that. I hope you guys have learned a lot from this video. I hope you now understand the Hawkins Kennedy. Once again, 90 degrees shoulder flexion with internal rotation, stabilized on both sides with the scapula. I've got her arm here, and then I'm going to crank down and ask, "was that the symptoms you're talking about?". -Yes. Good. So she has a positive Hawkin's on the left side. I look forward to hearing from you guys soon.  

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Hawkins Kennedy And Yokum Tests

Special tests for shoulder impingement. The Park et al. Shoulder Impingement Testing Cluster, Hawkin's Kennedy, Infraspinatus Strength Test, Painful Arc Test, Michiner et al. Shoulder Impingement Testing Cluster, Neer's Test, Empty Can Test, Supine Impingement Test (Screening Tool). The reliability, specificity, sensitivity, validity, safety, and screening for shoulder pain, rotator cuff tears, SLAP tears, supraspinatus pathology, bicep tendon tears, shoulder impingement syndrome (SIS), labrum (labral) tears, and general arm/shoulder pathology.

Shoulder Special Test: Hawkins-Kennedy and Yocum's Tests

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