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Shoulder Special Test: Kim's Test for Posterior Inferior Lesion of the Labrum
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Kim's Test for Posterior Inferior Labral Lesion is a physical examination technique used to assess for possible damage to the posterior inferior labrum, the cartilage found on the back edge of the shoulder joint. During the test, the examiner moves the affected arm from the side of the body in a circular motion, then applies pressure against the arm in a downward direction. If a posterior inferior labral tear is present, pain will usually be felt when the arm is moved downwards.
Transcript
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This is Brent of the Brookbush Institute, in
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...blank
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this video we're going over another
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special or orthopedic test for the
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shoulder, this is the Kim's test for
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posterior inferior labral lesions. Now I
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do have to admit that I referred to
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several texts before putting this down
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on video, and the reason being is every
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time I open to text, the written
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instructions didn't match the picture.
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Which sounds like a fairly simple almost
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juvenile problem,but it's not and you'll
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see why when i have my friend Melissa
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come out. So posterior inferior labral
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lesion. I believe the intent of this test
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is to okay if this is my glenoid fossa,
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I'm going to take your humeral head and
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I'm going to grind it in to your
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posterior inferior labrum, hoping to
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catch a tear or irritate a tear that has
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been created. We're going to say that you
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came in after landing on an outstretched
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arm, you felt some sudden pain in your
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shoulder and hasn't gone away. These are
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good indicators of some sort of labral
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issue. Now if i use the written
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instructions, they say 90 degrees of
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abduction. Well if i'm going to create
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compression, posterior and inferior glide.
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This doesn't totally make sense actually,
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because i end up pushing the humeral
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head kind of out of the glenoid fossa.
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Now all the pictures show this, this
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isn't 90 degrees of abduction, this is 90
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degrees of flexion. Then they say grab
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the mid-humerus and create a posterior
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and inferior force; that actually makes a
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little bit more sense, although we lose a
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lot of that compressive force now,
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because now our force is directed straight
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that way. It doesn't get any easier when
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they describe the test either, because
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they mentioned elevation of the arm.
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The elevation of the arm is generally a term
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used when flexion or abduction will do.
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What I think they're trying to get at
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here, is if I kind of go here I go to
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like 45 degrees,
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and then I posteriorly and inferiorly
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push on the humerus at mid-humerus,
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while elevating the arm into further
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somewhere between flexion and abduction;
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that's when i'll end up with a posterior
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and inferior force, as well as a little
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bit of compression. So this is the
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pictures, this is the written
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instructions, and this is what i'm
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suggesting. We got that clear it's a
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little complicated, so let's go over it
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one more time. What I'm going to have you
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guys do, is if somebody comes in and
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they're subjective evaluation is pointing towards some
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labral issues. The anterior labrum test or
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the SLAP lesion test came back negative.
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I'm starting to think okay let's look a
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little outside of the box, lets look at
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the posterior inferior labrum. You're going
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to elevate your patient's arm right,
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we're going to stay in that 45 degree
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plane. You're going to grab mid-humerus,
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you're going to push posterior and
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inferior while pulling the arm up this
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way, which is then going to create a
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posterior and inferior glide, forcing the
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humeral head into the posterior labrum.
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And since we're at 45 degrees, we'll be in
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good position to help keep a little bit
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of compression as well, so that we
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maintain force against the labrum. That's
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going to look something like this. Now a
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positive Kim's test, would be the sudden
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onset of pain in the posterior shoulder.
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So I'd go, hey is that the
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symptoms you're talking about? Yeah where
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do you feel those? In the back of your
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shoulder, that would be a positive Kim's
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test. All right so we're going to go
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ahead and bring the arm up to 90 degrees
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here of somewhere between abduction and
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flexion, grab mid-humerus, I'm pushing
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down that way while using this hand to
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pull up this way. Once again where do you
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feel that?
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In the back, thanks Melissa. With all of our tests
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with all of our diagnostic tests,
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remember that they're not that strong by
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themselves. These are clues so I'm going
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to want that subjective assessment, that
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subjective evaluation to be pointing me in the
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right direction; and then I'm going to
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back it up with not one diagnostic test,
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but several diagnostic tests. So if the
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Kim test is positive, and let's say the
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Jerk test is positive, and my SLAP tests
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were negative, but maybe some of my
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impingement tests are coming back a little
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positive, so that we know there's some
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definite dysfunction in the shoulder. Now
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I'm starting to think well, if it is a
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labral tear, I'm probably going to want
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to refer out for imaging first, and let
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the Physician decide whether conservative
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treatment should be tried first, before
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we even look at surgical options. Or is
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the damage so bad that we expect PTs,
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ATC's, Chiro's not to be able to have that
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much of an effect with conservative
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treatment to get this person back to
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their normal level of function. If you
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guys have any questions please feel free
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to drop me a line in the comment section
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underneath this video. You guys can go
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ahead and look up this test, and see
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the funny little discrepancy between the
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pictures and the written
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descriptions but don't let it persuade
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you. Use the test as I recommend it, and
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once again only use it as a clue. And I
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think within the body of evidence that
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you're trying to create to support your
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diagnosis or assessment, you'll be doing
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a great job. I look forward to talking to
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you guys soon.
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you
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