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The Hawkins-Kennedy test provokes pain by internally rotating the shoulder in 90° flexion, compressing rotator cuff tendons against the coracoacromial arch. A positive test suggests shoulder impingement syndrome.

Biceps tendinitis (B) is better detected with Speed’s test. Glenohumeral instability (C) requires apprehension/relocation testing. AC joint separation (D) produces localized pain over the joint, not impingement-type pain.

Accurate use of special tests ensures proper diagnosis, aligning with BOC/ACSM evaluation competencies.

Athletes with sickle cell trait can participate safely if self-pacing, hydration, and rest breaks are allowed. Education of staff and emergency planning are essential.

Maximal exertion (A) and dehydration (C) increase risk. Iron supplements (D) do not prevent sickling.

ACSM/NATA prevention guidelines emphasize modifications, monitoring, and readiness for exertional sickling emergencies.