Varus Stress Test of the Knee | Lateral Collateral Ligament Test Medicina | Free Full-Text | Valgus Arthritic Knee Responds Better to Elbow Varus Instability Stress TestLateral Collateral Ligament The use of the STARD tool is also a limitation. . Similarly, sensitivity figures ranged from 27% to 70% across the reviewed papers, generally indicating that a torn meniscus is likely to be missed in many patients; however, specificity figures (2996%) indicating that false positive tests are relatively low and that a positive test makes it likely that the patient actually does have a torn meniscus. National Library of Medicine McMurray's test is used to determine the presence of a meniscal tear within the knee. Anterior cruciate ligament reconstruction: MR imaging findings. Malanga GA, Andrus S, Nadler SF, McLean J. Merriman L, Turner W. Assessment of the Lower Limb. Valgus Stress Test followers, 12k True negative: the person does not have the disease and the test is negative. Described a modified version (Ege's test) but no description of McMurray's. YzQ2ZWY3MDkyMmRjMWVjYzY3ODhjNTExZjU4NGIzMTJjNjA3ZDA5Mzk3NTFl sharing sensitive information, make sure youre on a federal I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. It has been used previously for the systematic assessment of the methodology of studies into diagnostic accuracy10. Acute knee injuries: use of decision rules for selective radiograph ordering. Only one study by Harilainen et al. Once again, this affects the generalizability of the findings. Clinical Diagnostic Tests Versus MRI Diagnosis of ACL Tears. Generally, the McMurray's test has relatively high specificity and low sensitivity. The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network. In chronic injuries, this test has a sensitivity of 92% and a specificity of 91%, but not in acute injuries. An example of this would be as follows: If the McMurray's test had a LR+ of 9.2 for a particular study, a positive McMurray's test is 9.2 times more likely to occur in patients with a meniscal tear than in those without one29. Statistical evaluation of McMurray's test in the clinical diagnosis of meniscus injuries. 4th Edition. Purpose: Evans et al23 used consecutive patients on a waiting list for arthroscopy for a variety of conditions including, but not limited to, suspected meniscal tears. Further, subjects who are positive on the reference standard should reflect a continuum of severity, whereas those who are negative should have conditions commonly confused with meniscal tears17. Sae-Jung S, Jirarattanaphochai K, Benjasil T. KKU knee compression-rotation test for detection of meniscal tears: A comparative study of its diagnostic accuracy with the McMurray test. The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes. Grade III: The joint space opens 5 . These results have been supported by Karachalios et al21, who compared another weight-bearing modification (the Thessaly test) of the McMurray's with the original test. This was a purposeful strategy designed to enhance their ability to determine the true sensitivity and specificity of the McMurray's test in a population that reflects the symptomatic knee cohort that presents clinically. However, they only included patients who had had symptoms for at least one year, making extrapolation of their findings to the acute population challenging. document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); We use cookies to optimize our website and our service. Likelihood ratios overcome some of the problems involved with sensitivity and specificity values by summarizing the information contained in these values in a manner that can be used to quantify shifts in probability once the meniscal test results are known28. [1] Medial meniscus tears are generally seen more frequently than tears of the lateral meniscus, with a ratio of approximately 2:1. Other studies3,5,19 commented that greater clinical experience may affect the results of the test but they did not provide any statistical evidence to support this assertion. High sensitivity indicates that a test can be used for excluding a condition when it is negative, but it does not address the value of a positive test. Both arthroscopy and MRI have been used as a gold standard measure for detection of meniscal injuries in knees. ZmY3MzI2ODBmYTBhMDEzNzY3YmRkZjU0MDRhM2U2ODliZTFmOWMzYWI0MWI5 In: DeLee & Drez's Orthopaedic Sports Medicine. Epub 2018 Jul 27. A recent study by Winters and Tregonning13 showed a diagnostic accuracy for MRI to be 90% for the medial meniscus and 82% for the lateral meniscus. Comparable sensitivity and specificity were shown in regards to the Thessaly test, 85.4% and 54%, respectively. An LR+ indicates the degree of certainty that a patient with a positive test actually has the suspected condition while an LR indicates the degree of certainty that a patient with a negative test does not have the suspected condition27. Malanga GA, Andrus S, Nadler SF, McLean J. Flow diagram of literature screening process. DOI https://doi.org/10.1016/C2009-1-59662-1. Table Table55 shows the LR+ and LR for the 11 studies included within this review with 95% CIs. The sensitivity of a test reflects the proportion of people with the disease in question who are tested positive, whereas the specificity is the proportion of those without the disease who are tested negative. Fowler PJ, Lubliner JA. Hegedus EJ, Cook C, Hasselblad V, Goode A, McCrory DC. Background: Functional hallux limitus (FHL) refers to dorsiflexion hallux mobility limitation when the first metatarsal head is under loading conditions but not in the unloaded state. Validity of the McMurray's Test and Modified Versions of the Test: A Sensitivity can be defined as the proportion of patients with the condition who have a positive test result and represents the ability of the test to recognize the condition when present11. Studies were also not examined where they clearly did not meet the search criteria. More recent research has shown that modifications to the original McMurray's test may have better validity and diagnostic accuracy than the original McMurray's test3,58. A total of 232 patients were included: 98 patients in the FCL tear group (mean age: 33.6 12.2 years) and 134 patients in the control group (mean age: 44.0 17.2 years). 5, pp. Effect of Sectioning of the Anterior Cruciate Ligament and Posterolateral Structures on Lateral Compartment Gapping: A Randomized Biomechanical Study. As a stand-alone test, it had a sensitivity of 78% and specificity of 67% the pain was used as the outcome measure and a sensitivity of 91% and specificity of 49% when laxity was the outcome measure. It seems logical that those studies that include both pain and a click should have higher diagnostic value as compared to studies that just use one sign or the other. doi: 10.1016/j.eats.2018.10.007. McMurray test | Radiology Reference Article | Radiopaedia.org Clinical assessment of meniscal pathology in the knee has proven difficult due to the wide number of tests available and variations in their interpretation and application. Fritz JM, Wainner RS. The final study by Sae-Jung et al24 compared a modified version to McMurray's added axial compression, similar to that applied by Kurosaka et al6 but without added valgus or varus stress. A) AND B): The McMurray's test: Figure 1a) the tibia rotated on the femur into full internal rotation and Figure 1b) the tibia rotated on the femur into full external rotation. McMurrays Test - Physiopedia Confidence intervals could not be calculated32 from the data provided by these authors making it difficult to assess the accuracy of results. It is primary restraint to varus rotation from 0-30 of knee flexion. Disease paper 2 .pdf - Jade Smith BIOL 2301 Sec. 001 The objective of this paper was to critically review the literature with respect to the validity and diagnostic accuracy of the traditional McMurray's test and any modifications of this test. Original description. Currently, a triple phase technium-99 bone scan (scintigraphy) is the most accurate method of diagnosing stress fractures with a sensitivity of 100% and specificity of 76%. Diagnosis and treatment strategies of the multiligament injured knee: a Physical examination of the knee: a review of the original test description and scientific validity of common orthopedic tests. Consecutive patients clinically diagnosed as having torn menisci (based on symptoms of pain, locking, painful clicks, recurrent effusions, giving way or signs of extension block, wasting, or instability) Patients with evidence of fracture or arthritis, a previous history of surgery, or with an acute locked knee or haemarthrosis were excluded. The modified weight-bearing test showed a higher LR+ and a lower LR than the McMurray's test (Table (Table7).7). In most cases Physiopedia articles are a secondary source and so should not be used as references. Of the 11 studies identified in this review, nine used arthroscopy as the reference standard, one used MRI, and the remaining study used both MRI and arthroscopy (Table (Table44). Furthermore, the ability of both imaging modalities to identify an FCL injury was stratified based on acute versus chronic etiology. The sensitivity was 87% for the medial meniscus but only 46% for the lateral meniscus13. This generic search strategy was then combined with a subject-specific strategy (Table (Table1).1). Lateral Collateral Ligament of the Knee - Physiopedia However, other studies have shown MRI to be no more accurate than clinical examination for the diagnosis of meniscal tears14,15. Three of these studies had fairly broad inclusion criteria that better reflect the population seen in clinical practice with two including subjects with suspected meniscal or ligamentous pathology6,19; the study by Sae-jung et al24 included any patients identified as needing arthroscopy. Akseki D, Ozcan O, Boya H, Pinar H. A new weight-bearing meniscal test and a comparison with McMurray's test and joint line tenderness. Although the support of a clinical study is needed in order to make a definite conclusion, the dial test is probably not reliable in the presence of medial instability, The technical storage or access that is used exclusively for statistical purposes. The ligament lies laterally and posteriorly along the joint line. Apply slight lateral rotation and perform passive adduction at the knee joint and thus put stress on the LCL. Collectively, these studies indicate that there is little consensus in the reported measures of validity of the McMurray's test and that this is mostly due to limitations in the methodological quality of the studies that were assessed. Positive likelihood ratios presented in the studies reviewed generally indicated small to moderate shifts in probability (0.828.86) in that a positive test will indicate true meniscal pathology although the studies with the highest methodological quality demonstrated likelihood ratios considered to indicate moderate improvements in the probability that this will be the case3,4. A prospective evaluation of a test for lateral meniscal tears. Epub 2017 Aug 16. IR of the tibia + Varus stress = lateral meniscus. Failure to do this makes it difficult to determine if the findings of the study can be compared to other studies that have evaluated the same test. The Diagnostic Accuracy of Clinical Tests for Stress Fractures Three of the studies in this review considered a positive test to be the reproduction of a palpable thud or click4,6,22 (Table (Table4).4). Acute injuries excluded. MjUwZDBiZTEwYzA5YjkxZGRiYzI0YTE2MzY2ODI3ZDhjODQyYjNiZjU1YTU5 Schnke M, Schulte E, Schumacher U. Prometheus deel 1: Algemene anatomie en bewegingsapparaat. Evaluation of knee instability in acute ligamentous injuries. Partial Controlled Early Postoperative Weightbearing Versus Nonweightbearing After Reconstruction of the Fibular (Lateral) Collateral Ligament: A Randomized Controlled Trial and Equivalence Analysis. Sensitivity: 25%. = (Number of TP + Number of TN)/(Numbers of TP + FP + FN), Identifies article as a study of diagnostic accuracy, Describes study population (inclusion criteria, exclusion criteria, settings, locations), Describes data collection (prospective or respective), Describes reference standard and rationale, Describes technical Specifications of material and methods involved, Describes definition and rationale of units, cut-of points, or categories of results of tests, Describes number, training, and expertise of raters. Only one study by Harilainen et al. The accurate diagnosis of meniscal pathology on the basis of the findings of such tests is often difficult. Varus stress testing was performed in 20 of flexion, and testing in extension was not done. (PDF) Physical examination of the elbow, what is the evidence? A The IR of the tibia followed by extension, the examiner can test the entire posterior horn to the middle segment of the meniscus. LaPrade RF, DePhillipo NN, Cram TR, Cinque ME, Kennedy MI, Dornan GJ, O'Brien LT. Am J Sports Med. Unlike the medial meniscus, which is attached to the medial ligament, the lateral meniscus is not attached to the lateral ligament. The preliminary nature of this tool also means that a more narrative review of the validity and accuracy of the tests has been presented. With regard to negative likelihood ratios, all but three of the studies demonstrated only a small alteration in probability that a subject with a negative McMurray's test will not have a meniscal tear (Table (Table5).5). official website and that any information you provide is encrypted government site. Consecutive patients suspected of having meniscal tears presenting for arthroscopy: acute and chronic (ligament injuries excluded). Increased Accuracy of Varus Stress Radiographs Versus Magnetic Resonance Imaging in Diagnosing Fibular Collateral Ligament Grade III Tears. These authors also observed that the studies on these new tests have only been subjected to scientific scrutiny on one occasion and further research is required on these tests. Sensitivity: 25% . [4, 6] Thessaly Test. [5], The LCL stabilizes the lateral side of the knee joint, mainly in varus stress and posterolateral rotation of the tibia relative to the femur. Akseki et al3 compared the McMurray's test with a weight-bearing version of the McMurray's test that incorporated axial compression and varus/valgus stress, with the patient squatting down in internal and then external rotation (Ege's test). followers. A guide to the interpretation of likelihood ratio (LR) values. Six of the studies within this review included consecutive patients (Table (Table4).4). Sensitivity figures vary from 16%88%, while specificity figures vary from 20%98% (Table (Table5).5). The https:// ensures that you are connecting to the Valgus Stress Test. Finally, further independent research needs to compare the McMurray's test with modified tests to confirm the apparent superiority of these tests over the McMurray's test. Whiting WC, Zernicke RF. The reliability of this test in extension is 68% and in 30 flexion only 56%. Consequently, it is likely that the accuracy of meniscal testing demonstrated by this study is artificially high compared to studies with a wider inclusion criteria. Selection bias may occur when study subjects are not representative of the population on whom the test is typically applied in practice and can affect the results of a study11. Interpretation: If the knee joint adducts greater than normal (compared to the unaffected leg), the test is positive. Medline and CINAHL search strategy via OVID. Campbell SE, Sanders TG, Morrison WB. Solomon DH, Simel DL, Bates DW, Katz JN, Schafter JL. Patient in supine. Intertester reliability of clinical judgements of medial knee ligament integrity. In most cases Physiopedia articles are a secondary source and so should not be used as references. The findings of studies testing the validity of the McMurray's test have varied widely, mostly due to variations in the size and type of the study population as well as differences in description and application of the test3. This site needs JavaScript to work properly. NDkyMTlmYzMyYjdlN2RlZTQ2MjFiMjc5NGRhOWNjYWI3NTliM2NhYzM3YWNj However, these authors stated that they determined these findings in a study of 20 subjects prior to the main study and they did not provide any details of how this pilot study was performed or analyzed. ZDM4MDExNDhjN2VjY2ExMjE4ZTQxZWUwYTUzMGUzZDcwYWYzMDA5YTYwODZh Knee Sensitivity and Specificity: Flashcards | Quizlet Karachalios T, Hantes M, Zibis AH, Zachos V, Karantanas AH, Malizos KN. FOIA Rose NE, Gold SM. Based on the STARD scoring of each paper, it is possible to make a qualitative assessment about the methodological quality. The same maneuvers are performed in gradually increasing degrees of knee flexion to progressively load more posterior segments of the menisci. Varus Stress Test - Physical Therapy Haven [2] Harilainen A et al. Ocassionally, the LCL is congenitally absent. However, only Kurosaka et al6 and Evans et al23 made it clear that the examiners were not given any details about the subject's history so that they would not be influenced by this information. Based on MRI, overall specificity was 68%. Electronic databases (Medline, CINhAL, AMED, SPORTSDiscus, and SCOPUS) were searched from March 1980 to May 2008. Elsevier Health Sciences, 2014. One problem with these modified tests is that they appear to have all been evaluated by the creators of the tests, which to some degree challenges the validity of the research. If a study evaluates a test in a very specific group of patients, its findings can only be applied to that same type of cohort. Studies investigating the validity of diagnostic tests such as the McMurray's compare the findings of that test with a reference (gold) standard that has demonstrated validity11. Articles may have been missed based on the omission of certain search phrases or the use of a single search phrase as used in this case. A 95% CI is the most commonly used and indicates a range of values within which the population value would lie with 95% certainty. MGY4MmExODg4MDUwZTk2NzUzNjQ0OTMxYjkxN2QwYjQ5MmMxODdmMWU4MDdi The most sensitive test used in the diagnostics of medial meniscus lesions was the McMurray test, which showed a sensitivity of 87.5% with 52% specificity. If you believe Wordfence should be allowing you access to this site, please let them know using the steps below so they can investigate why this is happening. Guidelines for meta-analyses evaluating diagnostic tests. The McMurray's test, as described in Corea et al4, was designed to detect tears in the posterior segment of the meniscus. 2018 May 2;6(5):2325967118770170. doi: 10.1177/2325967118770170. Before and transmitted securely. Would you like email updates of new search results? ODA1ZGIwMjcwNDYzZDc3OTkwMWYwNWVkMWRlYzk1ZWExOTVhNjBiNWQ2MzUw Magee, D.J Chapter 12: Knee, in Orthopedic Physical Assessment. ZTU5MGVlOWM4MDcwMGE2YmJiZjNjZTBiMjQ2N2E5OTFmNTliZDgyYzc4ZjQ0 In order to make the retrieval of articles as comprehensive as possible, a generic search strategy was employed using Medline, CINAhL, and AMED databases through OVID, SPORTDiscus database through EBSCO, and SCOPUS, from 1980 to May 2008. A control group was composed of patients with an MRI and intact ACL and FCL. 269-273). MR imaging of meniscal cysts: incidence, location, and clinical significance. followers, 712k Churchill Livingstone, 2002. Specificity: 100% Valgus Stress Test: Sensitivity: 91% Specificity: 17% Varus Stress Test: Sensitivity: 25-77% Specificity: 98-99% Quadriceps Active Test: Sensitivity: 54-99% Specificity: 97-100% Posterior Sag Test: Inconclusive. Pg 791. [12] If the varus stress test is positive at 20, but negative at 0, only the LCL is torn. Manzotti A, Baiguini P, Locatelli A, et al. (2007)Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis. Kurosaka et al6 stated that diagnostic accuracy is lessened in patients with multiple pathologies, whereas Akseki et al3 found that there was no reduction in diagnostic accuracy with an associated tear of the ACL. There is conflicting evidence in the literature over the accuracy of MRI. As a library, NLM provides access to scientific literature. YWQ2ODI0ODM5NzE5MzVlYTlmMTRmMWEzM2NlYmU4OTViYTkwOTBmNjVjZGFj The predictive value of Thve clinical signs in the evaluation of meniscal pathology. 2017 Dec;33(12):2177-2181. doi: 10.1016/j.arthro.2017.06.028. The Valgus Test of the knee is performed with the patient lies in the supine position. Original Editors - Dorien Scheirs, Joris De Pot, Top Contributors - Saimat Lachinova, Admin, Joris De Pot, Dorien Scheirs, Kim Jackson, Rachael Lowe, Leana Louw, Oyemi Sillo, WikiSysop, Tony Lowe, Derycker Andries, Naomi O'Reilly, George Prudden and Kai A. Sigel. OThmMmM0YTcwMmQwODZhZWFkYzNjNzRlOTkzZiIsInNpZ25hdHVyZSI6IjVh During the maneuver, the joint line is palpated both medially and laterally. [2]Meniscal tears may occur in acute knee injuries in younger patients or as part of a degenerative process in older individuals. Knee Special Tests (Specificity & Sensitivity) Flashcards In general, sensitivity figures are much lower than specificity and the CI limits are wider. This is a key test to perform when assessing for posterolateral instability of the knee. There . Although sensitivity and specificity values provide useful information, they work against the direction of clinical testing11. When confidence intervals are not present, the CIs were incalculable due to absence of raw data. These comments are also supported by the findings of a recent meta-analysis carried out by Hegedus et al7 and Meserve et al8. Neuromusculoskeletal examination assessment: A handbook for therapists. Common terms. Measures of efficacy include accuracy, sensitivity, and specificity. This an indication of a LCL tear. 76, No. MRI has also shown to be highly reliable, but due to its expensive cost, they are less frequently used. Limitations of this review relate to the search strategy used. An assessment for one-plane lateral instability (i.e. The test is fairly solid. Arthroscopy has demonstrated an accuracy between 93% and 96%12. McMurray. The test is fairly solid. Methodological scores on the STARD (Standards for Reporting of Diagnostic Accuracy) yielded scores from 10/25 to 20/25. M2NhODMyZGZjNTEwMzAzY2JkMWI0MTUwM2I3NjNjN2RjYmY4NmEyNWE1ZjZk The purpose of this paper was to assess the literature investigating the validity and diagnostic accuracy of the McMurray's test (and modifications) for determining meniscal pathology of the knee so that conclusions could be drawn regarding its clinical usefulness as a test. They also fail to take into account pre-test probability. Evans et al23 compared a senior examiner with over 10 years experience to a medical student who had recently been taught the technique whereas Karachalios et al21 compared two experienced orthopaedic surgeons with two inexperienced residents.
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