Given the reported test characteristics, which test best rules in subacromial impingement due to high specificity?

• A. Painful arc
• B. Empty can test
• C. Hawkins-Kennedy Test
• D. Neer Impingement Test

Answer: (C)

Focusing on tests with high specificity helps you rule in a diagnosis when the result is positive. The Hawkins-Kennedy test does exactly that for subacromial impingement because it narrows the impingement mechanism to subacromial space compression of the rotator cuff tendons and bursa during forward flexion with internal rotation. A positive response—pain reproduced with this specific motion—strongly suggests impingement rather than other shoulder conditions, because this maneuver targets the subacromial structures specifically.

Other widely used tests tend to be more sensitive but less specific. The painful arc is good at catching impingement in many patients but can be positive in a range of shoulder issues, leading to more false positives. The empty can test and Neer’s test may also provoke pain in various shoulder pathologies, so they’re not as strong for confirming subacromial impingement on their own.

So, when the goal is to rule in subacromial impingement with a positive result, the Hawkins-Kennedy test is the best choice.