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This is Brent of the Brookbush Institute, in
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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.