0:04 This is Brent of the Brookbush Institute, in 0:06 this video we're going over another 0:07 special or orthopedic test for the 0:09 shoulder, this is the Kim's test for 0:12 posterior inferior labral lesions. Now I 0:16 do have to admit that I referred to 0:18 several texts before putting this down 0:21 on video, and the reason being is every 0:24 time I open to text, the written 0:27 instructions didn't match the picture. 0:30 Which sounds like a fairly simple almost 0:35 juvenile problem,but it's not and you'll 0:39 see why when i have my friend Melissa 0:40 come out. So posterior inferior labral 0:45 lesion. I believe the intent of this test 0:47 is to okay if this is my glenoid fossa, 0:50 I'm going to take your humeral head and 0:51 I'm going to grind it in to your 0:54 posterior inferior labrum, hoping to 0:57 catch a tear or irritate a tear that has 1:00 been created. We're going to say that you 1:03 came in after landing on an outstretched 1:05 arm, you felt some sudden pain in your 1:06 shoulder and hasn't gone away. These are 1:08 good indicators of some sort of labral 1:10 issue. Now if i use the written 1:12 instructions, they say 90 degrees of 1:15 abduction. Well if i'm going to create 1:18 compression, posterior and inferior glide. 1:23 This doesn't totally make sense actually, 1:26 because i end up pushing the humeral 1:29 head kind of out of the glenoid fossa. 1:31 Now all the pictures show this, this 1:36 isn't 90 degrees of abduction, this is 90 1:38 degrees of flexion. Then they say grab 1:40 the mid-humerus and create a posterior 1:43 and inferior force; that actually makes a 1:46 little bit more sense, although we lose a 1:48 lot of that compressive force now, 1:50 because now our force is directed straight 1:52 that way. It doesn't get any easier when 1:55 they describe the test either, because 1:57 they mentioned elevation of the arm. 1:58 The elevation of the arm is generally a term 2:00 used when flexion or abduction will do. 2:03 What I think they're trying to get at 2:05 here, is if I kind of go here I go to 2:10 like 45 degrees, 2:12 and then I posteriorly and inferiorly 2:15 push on the humerus at mid-humerus, 2:18 while elevating the arm into further 2:22 somewhere between flexion and abduction; 2:24 that's when i'll end up with a posterior 2:27 and inferior force, as well as a little 2:31 bit of compression. So this is the 2:35 pictures, this is the written 2:38 instructions, and this is what i'm 2:40 suggesting. We got that clear it's a 2:45 little complicated, so let's go over it 2:47 one more time. What I'm going to have you 2:49 guys do, is if somebody comes in and 2:51 they're subjective evaluation is pointing towards some 2:55 labral issues. The anterior labrum test or 3:00 the SLAP lesion test came back negative. 3:02 I'm starting to think okay let's look a 3:05 little outside of the box, lets look at 3:07 the posterior inferior labrum. You're going 3:10 to elevate your patient's arm right, 3:15 we're going to stay in that 45 degree 3:16 plane. You're going to grab mid-humerus, 3:21 you're going to push posterior and 3:23 inferior while pulling the arm up this 3:26 way, which is then going to create a 3:28 posterior and inferior glide, forcing the 3:30 humeral head into the posterior labrum. 3:32 And since we're at 45 degrees, we'll be in 3:35 good position to help keep a little bit 3:38 of compression as well, so that we 3:40 maintain force against the labrum. That's 3:43 going to look something like this. Now a 3:46 positive Kim's test, would be the sudden 3:49 onset of pain in the posterior shoulder. 3:52 So I'd go, hey is that the 3:54 symptoms you're talking about? Yeah where 3:56 do you feel those? In the back of your 3:59 shoulder, that would be a positive Kim's 4:01 test. All right so we're going to go 4:04 ahead and bring the arm up to 90 degrees 4:05 here of somewhere between abduction and 4:08 flexion, grab mid-humerus, I'm pushing 4:11 down that way while using this hand to 4:13 pull up this way. Once again where do you 4:16 feel that? 4:17 In the back, thanks Melissa. With all of our tests 4:22 with all of our diagnostic tests, 4:24 remember that they're not that strong by 4:28 themselves. These are clues so I'm going 4:30 to want that subjective assessment, that 4:33 subjective evaluation to be pointing me in the 4:36 right direction; and then I'm going to 4:38 back it up with not one diagnostic test, 4:41 but several diagnostic tests. So if the 4:45 Kim test is positive, and let's say the 4:48 Jerk test is positive, and my SLAP tests 4:51 were negative, but maybe some of my 4:54 impingement tests are coming back a little 4:56 positive, so that we know there's some 4:57 definite dysfunction in the shoulder. Now 5:00 I'm starting to think well, if it is a 5:03 labral tear, I'm probably going to want 5:05 to refer out for imaging first, and let 5:09 the Physician decide whether conservative 5:12 treatment should be tried first, before 5:16 we even look at surgical options. Or is 5:19 the damage so bad that we expect PTs, 5:23 ATC's, Chiro's not to be able to have that 5:27 much of an effect with conservative 5:29 treatment to get this person back to 5:31 their normal level of function. If you 5:33 guys have any questions please feel free 5:35 to drop me a line in the comment section 5:37 underneath this video. You guys can go 5:40 ahead and look up this test, and see 5:42 the funny little discrepancy between the 5:44 pictures and the written 5:46 descriptions but don't let it persuade 5:49 you. Use the test as I recommend it, and 5:52 once again only use it as a clue. And I 5:55 think within the body of evidence that 5:57 you're trying to create to support your 5:59 diagnosis or assessment, you'll be doing 6:02 a great job. I look forward to talking to 6:04 you guys soon. 6:13 you 6:15 Subtitles by the Amara.org community
