Kim test: How to perform, interpret, and document it

Key takeaways

The Kim test checks for a posteroinferior labral tear, the injury that anterior instability tests tend to miss.

Seat the patient, abduct the arm to 90 degrees, apply an axial load, then elevate 45 degrees with a posteroinferior glide.

A positive result is a sudden onset of posterior shoulder pain, whether or not a clunk comes with it.

Accuracy sits at roughly 80% sensitivity and 94% specificity, and adding the jerk test lifts combined sensitivity to about 97%.

Record the side tested, the force applied, and the patient’s own words, so a positive test turns into an imaging referral.

Posterior labral tears hide behind ordinary shoulder pain. Your patient describes a deep ache at the back of the joint, plus a click when they reach across their body. The anterior instability tests come back clean, and the picture stays muddy.

The Kim test was built for that presentation. It loads the posteroinferior labrum directly, so a positive result gives you a firm reason to request imaging. Hold the arm loosely or push in the wrong direction, though, and the result tells you very little. Technique is most of the value here.

The Kim test targets the posteroinferior labrum

The Kim test is an orthopedic special test for posteroinferior labral tears of the glenohumeral joint. Seung-Ho Kim and colleagues described it in the American Journal of Sports Medicine in 2005, alongside a head-to-head comparison with the jerk test. It is now a routine part of shoulder instability assessment in physical therapy and sports medicine.

The posteroinferior labrum is the rim of fibrocartilage that deepens the socket at the back and underside of the glenoid. It resists the humeral head sliding backward and downward when the arm is loaded. Once that rim tears, patients report catching, a sense of the joint slipping, and pain in specific positions.

The test works by recreating that mechanism. You compress the joint, then push the humeral head down and back while lifting the arm on a diagonal. If the labrum is torn, the force provokes it, and the patient feels it straight away.

How to perform the Kim test in four steps

The whole test takes under a minute. Work through it in the same order every time, because the result depends on where the arm sits and where the force goes.

Step 1: Seat the patient and support the scapula

Sit the patient upright in a chair with a back rest. The chair back stabilizes the scapula, which stops it tilting away and unloading the labrum. Ask them to let the shoulder relax. A shrugged, guarded shoulder changes the mechanics and blurs the finding.

Step 2: Hold the elbow and the proximal humerus

Stand behind the patient, on the side you are testing. Grasp the elbow with one hand and the mid to proximal humerus with the other. Raise the arm to 90 degrees of abduction. Both hands stay on the arm, because each one applies a different part of the force.

Step 3: Load the joint, then elevate 45 degrees

With the arm at 90 degrees, apply a steady axial load along the humerus, pushing the head into the socket. Now elevate the distal humerus about 45 degrees on an oblique diagonal. At the same time, glide the proximal humerus down and back with your other hand. Build the force smoothly. Sudden jerking belongs to the jerk test, not this one.

Step 4: Watch for sudden posterior pain

A positive Kim test is a sudden onset of posterior shoulder pain during the maneuver. A jerk or clunk may come with it, but it does not have to. The pain alone is enough. Release the force as soon as the patient reports it, then write down what they said in their own words.

A positive Kim test rules in, a negative one does not rule out

Treat a positive Kim test as strong support for a posteroinferior labral tear, not as the diagnosis. Confirmation still needs MRI or an MR arthrogram. Posterior capsule tightness, rotator cuff pathology, and posterior impingement all sit in the same differential.

The numbers make the asymmetry clear. Take a patient whose history and injury mechanism put the odds of a labral tear at roughly 40%. A positive Kim test lifts that to about 90%. A negative test only brings it down to about 12%, which is low but not zero.

So a negative result should not close the case when the story still points at the labrum. Around one tear in five produces a negative test, usually the smaller lesions with little mechanical instability. Clinical context decides your next move. A positive test in a young thrower with a history of subluxation carries real weight. The same finding in a sedentary patient with a gradual ache carries much less.

Diagnostic accuracy: What the Kim test numbers mean

The original 2005 study remains the reference point, and it measured the test against arthroscopic findings.

High specificity is what makes a positive result useful. Sensitivity of 80% is good, but it still leaves room for false negatives. That is the argument for pairing the test rather than running it alone.

Kim test vs jerk test: Run both, not one

Both tests interrogate the same structure, and they pick up different lesions. The Kim test is more sensitive when the tear sits predominantly inferior. The jerk test is more sensitive when it sits predominantly posterior. Run the pair and combined sensitivity reaches about 97%.

The practical takeaway is simple. Two positives together make a posteroinferior labral tear very likely, and imaging is clearly indicated. When the tests disagree, weigh the patient’s history and where their symptoms actually sit before you refer.

Where the Kim test sits in the instability battery

The Kim test answers one question, so it works best inside a short sequence. Three other tests map the rest of the joint.

• Jerk test: Horizontal adduction with internal rotation and a posterior push. Very high specificity, so it is the natural confirmation for a positive Kim test.
• Load and shift test: Grades anteroposterior translation of the humeral head with the patient supine. Useful for judging how much laxity you are dealing with.
• Apprehension and relocation tests: Cover the anterior compartment. Apprehension in abduction and external rotation that settles with a posterior push points to anterior instability instead.

The full battery takes five to 10 minutes. Sequencing matters more than speed, so leave the most provocative test until last. Once a patient has felt a genuine apprehension response, they guard, and everything after that gets harder to read.

Documenting the Kim test so the result gets acted on

A Kim test that never reaches the record cannot trigger a referral. Write it up the same way every time, in enough detail that a colleague could repeat the test and compare. A standard SOAP note structure handles it in four lines.

• Subjective: What the patient felt, quoted where you can, plus severity as mild, moderate, or severe.
• Objective: Side tested, arm position, direction of force, examiner position, and whether a click or clunk was present.
• Assessment: Positive or negative, and how that result fits the rest of the shoulder exam.
• Plan: Imaging referral, conservative management, review date, and who is following up.

Two details slip most often: the side tested and the exact wording of the patient’s response. Both matter later. “Sharp pain at the back of the shoulder” supports a labral referral, while “felt tight” does not.

If your notes are digital, build the test into the form instead of leaving it to free text. A structured field forces the result to be recorded, and it keeps the finding searchable when you audit outcomes. Digital assessment forms also stop half-finished exams being saved.

Who gets the most out of the Kim test template

Anyone who assesses shoulders on a schedule. Physical therapists, or physiotherapists in the UK, get a fixed order of operations, so nothing is skipped when the day runs late. Occupational therapists can slot the test into a wider upper limb assessment.

Multi-site practices get something else from it: comparability. When every clinician records the same fields, a medical director can audit how often positive tests led to imaging. They can also check how often imaging confirmed the tear. Athletic trainers working pitchside need the opposite. They need a form short enough to finish on a phone.

The template works on paper and as a digital form. Either way it does the same job. It stops the finding living only in someone’s memory.

How Pabau keeps Kim test findings in the patient record

Most of the risk around special tests is administrative, not clinical. The test gets done, the result gets mentioned in passing, and the referral never gets raised. Practice management software like Pabau closes that loop by keeping the assessment and the follow-up in one record.

You can build the Kim test into a digital form with fixed fields for position, force, findings, and plan. The completed form saves straight to the client record, so the next clinician sees the finding without asking. Pabau Scribe, our AI scribe, can draft the note from the consultation, which leaves you checking the wording instead of typing it.

The follow-up then runs on the same system. Book the review appointment, attach the imaging request to the record, and set a reminder so nothing waits on someone remembering. Reporting shows you how many positive tests became confirmed diagnoses across the team.

Keep every special test result in the record

Build the Kim test into a digital assessment form and save the result straight to the client record. Pabau Scribe can draft the note for you.

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Conclusion

The Kim test earns its place because it is quick, repeatable, and specific. A positive result is a strong reason to request imaging. A negative result narrows your thinking without closing the door.

What happens after the test is what changes outcomes. Standardize the arm position, standardize the wording in your notes, and pair the Kim test with the jerk test whenever instability is on the table. Then make sure positive results leave the building as referrals.

Download the template above to keep shoulder assessment consistent across your team. Book a demo to see how Pabau keeps assessment findings, referrals, and follow-ups in one patient record.

Continue your research

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Want your special test notes to read cleanly? SOAP notes examples shows how to structure subjective and objective findings without padding.

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Running a physical therapy practice in the UK? Mandatory compliance for physiotherapy clinics covers the record-keeping standards your notes have to meet.

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