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.
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.
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
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
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
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.
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
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
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.
Assessment chair or plinth
Documentation system
Pain/symptom rating scale if used
No specialised equipment is required.
The client sits upright in a relaxed seated position.
Seated
Shoulder abducted to approximately 90 degrees
Elbow flexed
Stand beside the shoulder being assessed.
One hand stabilises the scapular region
The other hand supports the arm near the elbow
Maintain scapular control throughout the movement to reduce excessive compensation.
Apply axial compression through the humerus.
Elevate the arm diagonally upward.
Simultaneously apply a posteroinferior force to the proximal arm.
Ask the client to:
remain relaxed
report pain or instability
describe clicking or catching
report reproduction of familiar symptoms
A positive Kim Test may involve:
posterior shoulder pain
painful clunk
clicking
instability sensation
reproduction of familiar symptoms
A negative finding is the absence of familiar symptom reproduction during testing.
Stop testing if:
severe pain occurs
instability becomes excessive
guarding prevents safe testing
neurological symptoms appear
Force should be applied gradually and controlled. Symptom irritability should guide testing intensity.
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
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
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.
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 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.
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
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 shoulder assessment tests may include:
Jerk Test
Load and Shift Test
O’Brien’s Test
Posterior Apprehension Test
Scapular Retraction Test
Neer’s Test
The Kim Test may help increase suspicion of posterior labral involvement in some populations, but it does not confirm structural pathology independently.
A positive finding commonly involves posterior shoulder pain, clicking, clunking or instability sensation during the manoeuvre.
No. A negative finding may reduce suspicion in some cases, but it does not fully exclude pathology.
Yes. Symptom reproduction may also occur with other shoulder presentations including rotator cuff irritation, instability or scapular dysfunction.
No. Shoulder orthopaedic tests are generally more useful when interpreted alongside history, movement assessment and additional findings.
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.
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
