The Kim Test is a shoulder orthopaedic test commonly used to assess posterior shoulder symptom provocation and posterior-inferior labral involvement. It is typically used in people with posterior shoulder pain, instability symptoms or painful clicking during shoulder movement. This article explains how to perform the Kim Test, how to interpret positive and negative findings, current evidence surrounding diagnostic accuracy, practical limitations and how to document findings consistently.

Introduction

Posterior shoulder pain and instability presentations can be difficult to assess because symptoms often overlap with rotator cuff irritation, scapular dysfunction, internal impingement and other labral presentations. The Kim Test is one of several orthopaedic shoulder tests designed to reproduce posterior shoulder symptoms and support assessment reasoning when posterior labral involvement or posterior instability is suspected.

The test is commonly used alongside:

• history and symptom behaviour
• movement assessment
• instability testing
• scapular assessment
• additional labral tests
• functional loading assessment

Although the Kim Test may help increase suspicion of posterior-inferior labral involvement in some populations, it should not be interpreted as a stand-alone diagnostic tool. Diagnostic accuracy varies depending on the population studied, testing method, symptom irritability and reference standard used.

A structured and consistent testing approach can improve repeatability, communication and long-term monitoring.

Quick Summary

• Primary purpose: Assess posterior shoulder symptom provocation and posterior-inferior labral involvement
• Body region: Shoulder
• Commonly associated with: Posterior shoulder instability and posterior labral irritation
• Positive finding: Posterior shoulder pain, painful clunk, clicking or instability sensation
• Negative finding: No reproduction of familiar symptoms
• Clinical role: Supports assessment reasoning but does not confirm pathology on its own
• Best interpreted with: History, symptom behaviour and additional shoulder assessment findings

What Is the Kim Test?

The Kim Test is a shoulder orthopaedic test originally described to assess posterior-inferior labral involvement and posterior instability presentations.

The test places the shoulder under a combined axial loading and diagonal elevation movement while applying a posteroinferior force to the proximal arm. This movement is intended to stress the posterior-inferior capsulolabral region and potentially reproduce familiar symptoms.

The Kim Test is commonly discussed alongside:

• Jerk Test
• posterior apprehension testing
• Load and Shift Test
• O’Brien’s Test
• scapular control assessment

The test is most relevant in people reporting:

• posterior shoulder pain
• instability sensations
• painful clicking or clunking
• symptoms during pressing or pushing
• symptoms during overhead activity

Why It Is Used

The Kim Test may help:

• reproduce posterior shoulder symptoms
• increase suspicion of posterior-inferior labral involvement
• assess posterior shoulder irritability
• support shoulder instability assessment reasoning
• contribute to shoulder test clustering
• guide further assessment decisions

It may be particularly relevant in:

• overhead athletes
• contact athletes
• gym-based athletes
• throwing sports
• combat sports
• clients reporting recurrent posterior shoulder symptoms

The test should be interpreted cautiously because posterior shoulder pain may also relate to:

• rotator cuff irritation
• internal impingement
• scapular dyskinesis
• posterior capsule stiffness
• muscular guarding
• referred pain

What It Assesses

The Kim Test is intended to stress structures associated with:

• posterior-inferior glenoid labrum
• posterior capsulolabral complex
• posterior shoulder stabilising structures

A positive finding may be associated with:

• posterior labral irritation
• posterior instability presentations
• posterior capsulolabral dysfunction

However, the test does not directly visualise tissue injury and cannot confirm structural pathology independently.

Who It Is Useful For

The Kim Test may be useful for:

• exercise professionals
• strength and conditioning coaches
• sports performance professionals
• movement assessment education
• allied health assessment settings
• shoulder screening
• return-to-training monitoring
• overhead athlete assessment

It may be particularly useful when symptoms involve:

• posterior shoulder pain
• instability sensations
• painful clicking
• loaded horizontal movements
• repetitive overhead activity

When to Use This Test

Consider using the Kim Test when a client reports:

• posterior shoulder pain
• instability sensations
• painful clicking or catching
• symptoms during pressing movements
• symptoms during throwing or overhead loading
• recurrent posterior shoulder irritation

The test may become more meaningful when combined with:

• symptom history
• instability history
• movement assessment
• functional testing
• posterior apprehension findings
• additional labral tests

When Not to Use or When to Be Cautious

Use caution when:

• symptoms are highly irritable
• acute trauma is suspected
• recent dislocation occurred
• severe pain is present
• fracture is suspected
• post-operative restrictions exist
• neurological symptoms dominate the presentation

Stop testing if:

• pain becomes severe
• guarding becomes excessive
• instability symptoms escalate significantly
• the client requests cessation

Avoid aggressive force application, especially in highly irritable shoulders.

Equipment Required

• Assessment chair or plinth
• Documentation system
• Pain/symptom rating scale if used

No specialised equipment is required.

Step-by-Step Protocol / Practice

Setup

The client sits upright in a relaxed seated position.

Client Position

• Seated
• Shoulder abducted to approximately 90 degrees
• Elbow flexed

Examiner/Professional Position

Stand beside the shoulder being assessed.

Hand Placement

• One hand stabilises the scapular region
• The other hand supports the arm near the elbow

Stabilisation

Maintain scapular control throughout the movement to reduce excessive compensation.

Movement and Force Direction

1. Apply axial compression through the humerus.
2. Elevate the arm diagonally upward.
3. Simultaneously apply a posteroinferior force to the proximal arm.

Instructions

Ask the client to:

• remain relaxed
• report pain or instability
• describe clicking or catching
• report reproduction of familiar symptoms

Positive Finding

A positive Kim Test may involve:

• posterior shoulder pain
• painful clunk
• clicking
• instability sensation
• reproduction of familiar symptoms

Negative Finding

A negative finding is the absence of familiar symptom reproduction during testing.

Stopping Criteria

Stop testing if:

• severe pain occurs
• instability becomes excessive
• guarding prevents safe testing
• neurological symptoms appear

Safety Notes

Force should be applied gradually and controlled. Symptom irritability should guide testing intensity.

Positive and Negative Test Interpretation

Positive Test Interpretation

A positive Kim Test may increase suspicion of:

• posterior-inferior labral involvement
• posterior instability
• posterior capsulolabral irritation

The finding may be more meaningful when combined with:

• instability history
• overhead sporting demands
• traumatic mechanism
• positive Jerk Test
• recurrent posterior symptoms
• mechanical symptoms

However, a positive finding does not confirm a labral tear or structural injury independently.

Similar symptoms may also occur with:

• rotator cuff irritation
• internal impingement
• scapular dysfunction
• posterior shoulder stiffness
• muscular guarding

Negative Test Interpretation

A negative Kim Test may reduce suspicion of posterior-inferior labral involvement in some populations.

However:

• a negative finding does not fully exclude pathology
• some labral presentations may not reproduce symptoms
• guarding and irritability may affect results
• diagnostic accuracy varies across studies

Further assessment may still be appropriate if:

• instability symptoms persist
• history strongly suggests posterior instability
• functional symptoms remain significant
• mechanical symptoms continue

Sensitivity, Specificity and Diagnostic Accuracy

The Kim Test was originally described by Kim et al. in a surgical population with suspected posterior labral pathology.

The original study reported:

• Sensitivity: approximately 80%
• Specificity: approximately 94%

Reference standard:

• Arthroscopic findings

Population:

• Patients with suspected posterior labral lesions

More recent systematic reviews and shoulder special test literature suggest that:

• diagnostic accuracy for shoulder orthopaedic tests varies considerably
• isolated shoulder tests often perform less consistently outside surgical populations
• combinations of findings are usually more useful than single tests alone

A 2020 systematic review examining shoulder special tests highlighted ongoing limitations in diagnostic accuracy research due to:

• study heterogeneity
• inconsistent protocols
• variable reference standards
• spectrum bias
• differing patient populations

Higher specificity may make a positive finding more useful for increasing suspicion in appropriate clinical contexts. However, the Kim Test does not confirm posterior labral pathology on its own.

Similarly, a negative result may reduce suspicion in some populations but does not fully exclude pathology.

Evidence for this test should therefore be interpreted as part of broader assessment reasoning rather than as a stand-alone diagnostic decision.

Reliability and Validity

High-quality reliability evidence specific to the Kim Test remains limited.

Current literature suggests reliability may be influenced by:

• examiner experience
• consistency of scapular stabilisation
• force direction
• symptom irritability
• movement speed
• testing standardisation

At the time of writing:

• strong evidence for SEM or MDC values specific to the Kim Test appears limited
• inter-rater reliability evidence remains sparse
• validity evidence is primarily based on diagnostic comparison studies in surgical populations

Consistent positioning, communication and force application may improve repeatability.

Common Errors and Limitations

Common testing errors include:

• inadequate scapular stabilisation
• excessive force application
• inconsistent arm positioning
• poor symptom clarification
• moving too aggressively
• failure to compare symptom behaviour

Key limitations include:

• variable diagnostic accuracy
• overlap with other shoulder conditions
• dependence on symptom reproduction
• inconsistent protocols between studies
• limited stand-alone value

The Kim Test should not replace comprehensive shoulder assessment.

Practical Applications

The Kim Test may help:

• support shoulder assessment reasoning
• monitor symptom behaviour over time
• contribute to instability assessment clusters
• guide referral discussions
• improve structured documentation

The test is often most useful when interpreted alongside:

• history
• movement assessment
• strength testing
• instability assessment
• scapular assessment
• functional loading tolerance

How to Record This in Measurz

Record:

• Test name: Kim Test
• Side tested
• Positive, negative, unclear or unable to test
• Pain score
• Symptom location
• Symptom quality
• Presence of clicking or clunking
• Instability sensation
• Arm position used
• Force direction
• Comparison side findings
• Irritability level
• Guarding
• Compensations
• Reason for stopping if applicable
• Related shoulder findings
• Retest date
• Referral considerations if relevant

Detailed recording improves:

• repeatability
• communication
• progress monitoring
• assessment reasoning
• long-term reporting quality

Related Tests / Internal Links

Related shoulder assessment tests may include:

• Jerk Test
• Load and Shift Test
• O’Brien’s Test
• Posterior Apprehension Test
• Scapular Retraction Test
• Neer’s Test

FAQs

Is the Kim Test accurate for posterior labral injuries?

The Kim Test may help increase suspicion of posterior labral involvement in some populations, but it does not confirm structural pathology independently.

What is considered a positive Kim Test?

A positive finding commonly involves posterior shoulder pain, clicking, clunking or instability sensation during the manoeuvre.

Does a negative Kim Test rule out posterior instability?

No. A negative finding may reduce suspicion in some cases, but it does not fully exclude pathology.

Can the Kim Test reproduce symptoms without a labral tear?

Yes. Symptom reproduction may also occur with other shoulder presentations including rotator cuff irritation, instability or scapular dysfunction.

Should the Kim Test be used alone?

No. Shoulder orthopaedic tests are generally more useful when interpreted alongside history, movement assessment and additional findings.

Key Takeaways

• The Kim Test is used to assess posterior shoulder symptom provocation and posterior-inferior labral involvement.
• A positive finding may increase suspicion of posterior instability presentations.
• The test does not confirm structural pathology independently.
• Diagnostic accuracy varies depending on population and methodology.
• Shoulder orthopaedic tests are generally more useful when combined with broader assessment findings.
• Consistent documentation improves repeatability and monitoring over time.

References

Cook, C., & Hegedus, E. J. (2021). Orthopedic physical examination tests: An evidence-based approach (3rd ed.). Pearson.

Hegedus, E. J., Cook, C., Lewis, J., Wright, A., & Park, J. Y. (2015). Combining orthopedic special tests to improve diagnosis of shoulder pathology. Physical Therapy in Sport, 16(2), 87–92. https://doi.org/10.1016/j.ptsp.2014.08.001

Kim, S. H., Ha, K. I., Yoo, J. C., Noh, K. C., & Kim, Y. S. (2005). 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(8), 1188–1192. https://doi.org/10.1177/0363546504272689

Morrow, E. K., Morris, J. H., & Struyf, F. (2020). Clinical examination and physical assessment of shoulder pain. British Journal of Sports Medicine, 54(20), 1208–1215. https://doi.org/10.1136/bjsports-2019-101168

Pizzari, T., & Jaggi, A. (2021). Shoulder instability: Current approaches to assessment and management. Journal of Orthopaedic & Sports Physical Therapy, 51(7), 347–356. https://doi.org/10.2519/jospt.2021.0607