Kim Test for Posteroinferior Labral Lesion

Kim test is a novel diagnostic test that is used to detect a posteroinferior labral lesion of the shoulder joint. It’s a modification of jerk test.

Kim lesion: concealed incomplete avulsion of posteroinferior aspect of labrum.

How do you perform the Kim Test?

This test is done with the patient sitting, and the clinician standing on the involved side. The clinician grasps the elbow with one hand and the mid humeral region with the other hand, then elevates the patient’s arm to 90 degrees of abduction. Simultaneously, the clinician provides an axial load to the humerus and a 45-degree diagonal elevation to the distal humerus concurrent with a posteroinferior glide to the proximal humerus.

The developers also suggested that the test could be performed in a chair with a solid backing (or supine on the examination table, as we suggest) to help stabilize the scapula during axial loading.

See Also: Shoulder SLAP Lesion

What does a positive Kim Test mean?

A positive test is indicated by a sudden onset of posterior shoulder pain, regardless of whether a “jerk” or a “clunk” occurred.

See Also: Jerk Test

Accuracy

The investigators performed a study in which the diagnostic efficacy of the Kim test was compared to that of the jerk test in the diagnosis of posteroinferior labral lesions in 172 painful shoulders. Two clinicians performed the examinations in order to calculate inter-observer reliability. In that study, 33 shoulders had a positive Kim test, of which 24 actually had a posteroinferior labral lesion (nine false positives). Of the remaining 139 shoulders that had a negative Kim test, 6 shoulders actually did have a posteroinferior labral lesion (six false negatives).

Based on this data, the sensitivity of the Kim test was 80 %, the specificity was 94 %, the PPV was 73 %, and the NPV was 96 % with an excellent inter-observer ICC of 0.96.

The results of their study indicated that the Kim test was more sensitive in the detection of predominantly inferior labral lesions whereas the jerk test was more sensitive in the detection of predominantly posterior labral lesions.

The combination of tests improved the overall sensitivity to approximately 97 % for the detection of posteroinferior labral lesions.

References

• Kim SH, Park JS, Jeong WK, et al: The Kim test: A novel test for posteroinferior labral lesion of the shoulder- a comparison to the jerk test. The American journal of sports medicine 33:1188–92, 2005. PMID: 16000664
• Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.