[4, 6] Thessaly Test. Sensitivity: 25%. 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. These findings are contrasted by those of Karachalios et al21, who reported a 95% agreement for both intra- and intertester reliability for all of the clinical tests they employed. This an indication of a LCL tear. Varus Stress Test Purpose: To assess the integrity of the LCL. Six of the studies within this review included consecutive patients (Table (Table4).4). Accuracy is the percentage of subjects who are correctly identified as either having or not having a meniscal tear. ODA1ZGIwMjcwNDYzZDc3OTkwMWYwNWVkMWRlYzk1ZWExOTVhNjBiNWQ2MzUw An assessment for one-plane medial instability (gapping of the tibia away from the femur on the medial side). PDF ssslideshare.com Also described a weight-bearing modification of McMurray's (Thessaly test), n/m for McMurray's, but joint line discomfort and possibly a sensation of locking or catching for Thessaly test. A guide to the interpretation of likelihood ratio (LR) values. 2006;20:8594. OWFmOGE3YWY0OWM1ZWIzOTU5Mjg5Y2I4ODIwZmU1MmQyZWRhMmUxY2ZlMGU3 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. 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. . Patients identified as needing arthroscopy excluding those with intra-articular fracture, neurological or degenerative disorders. Based on chronicity of the injuries, MRI was more accurate for detecting acute FCL injuries than chronic injuries (P = .002), and varus stress radiographs were more accurate for detecting chronic FCL injuries than acute injuries (P = .041). Winters K, Tregonning R. Reliability of magnetic resonance imaging of the traumatic knee as determined by arthroscopy. Take the leg and bring it in 30 Flexion (MLPP) and use a cushion or edge of the bed so the patient can relax. Irwig L, Tosteson AN, Gatsonis C, et al. Use of methodological standards in diagnostic test research: Getting better but still not good. Edinburgh: Elsevier, 2006. OThmMmM0YTcwMmQwODZhZWFkYzNjNzRlOTkzZiIsInNpZ25hdHVyZSI6IjVh Sensitivity: 25% . Fritz JM, Wainner RS. Intertester reliability of clinical judgements of medial knee ligament integrity. Acute patients (< 6 weeks) excluded. A recent literature review on composite testing of the diagnostic tests for the meniscus reported reasonable sensitivity and specificity when the findings of a number of tests are combined31. (PDF) Physical examination of the elbow, what is the evidence? A 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). 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. Modified McMurray's to include valgus/varus stress. 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. This is a key test to perform when assessing for posterolateral instability of the knee. Sensitivity and specificity of diagnosing FCL injuries on MRI were determined based on review by a fellowship-trained musculoskeletal radiologist, blinded to the pathology associated with each patient (FCL injury vs control), and compared with the gold standard of examination under anesthesia, followed by surgical confirmation of an FCL tear at the time of FCL reconstruction. Both arthroscopy and MRI have been used as a gold standard measure for detection of meniscal injuries in knees. Would you like email updates of new search results? 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. Interactive Content (Direct Video Demonstration, PubMed articles), Statistical Values for all Special Tests from the latest research, Currently on Version 6.0 Free lifetime updates. Effect of Sectioning of the Anterior Cruciate Ligament and Posterolateral Structures on Lateral Compartment Gapping: A Randomized Biomechanical Study. The sensitivity of diagnosing an FCL injury based on varus stress radiographs was also determined. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. LaPrade RF, DePhillipo NN, Cram TR, Cinque ME, Kennedy MI, Dornan GJ, O'Brien LT. Am J Sports Med. All patients who underwent an isolated FCL or combined anterior cruciate ligament (ACL)/FCL reconstruction by a single surgeon between 2010 and 2017 with preoperative varus stress radiographs and magnetic resonance imaging (MRI) were included in this study. The varying definitions of a positive McMurray's test are also likely to have contributed to the variability of the results demonstrated by the studies reviewed. 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. The Medial-Lateral Grind test had a higher LR+ (Table (Table7)7) when compared to the McMurray's test; however, its CIs were extremely wide, bringing into question the precision of this estimate of reliability (Table (Table7).7). Original description. It is primary restraint to varus rotation from 0-30 of knee flexion. When evaluating any diagnostic test, commonly used parameters are its sensitivity and specificity. Mariani et al30 have suggested that the differences in anatomical attachments of the two menisci contribute to these variations in sensitivity and specificity of diagnostic tests30. The test has therefore often been reported to be of limited value in current clinical practice. Solomon DH, Simel DL, Bates DW, Katz JN, Schafter JL. This is true in the case of the study by Akseki et al3 but not for the study by Evans et al23 (Tables (Tables44 and and55). Varus stress testing was performed in 20 of flexion, and testing in extension was not done. Anderson and Lipscomb5 compared the McMurray's test to a test termed the Medial-Lateral Grind test that included a varus/valgus component not included in the original McMurray's test. The clinician hold the patient's ankle with one hand, while the other hand is on the lateral condyle of the femur. the contents by NLM or the National Institutes of Health. Symptoms related to an intra-articular knee pathology. In an analysis of 20 available studies, the mean sensitivity and specificity of the anterior drawer test were 38% to 81% in awake patients and 63% to 91% in anesthetized patients, respectively. Fowler and Lubliner22 had a similarly broad population in that they included consecutive patients who warranted arthroscopic examination for any reason. AP and lateral radiographic images of a SE-4 fracture - ResearchGate YmQ4NDJhMzZkOWUyMDUwNzAxN2M3ZjVhOGYyYmU0ZDVkYWUxNWM0ZGFhMTFi These comments are also supported by the findings of a recent meta-analysis carried out by Hegedus et al7 and Meserve et al8. This means that tests rarely have both high sensitivity and specificity. The proportion of people who test positive and who have the disease or dysfunction. DOI https://doi.org/10.1016/C2009-1-59662-1. Bethesda, MD 20894, Web Policies 1173185. See also: stress test Apply slight lateral rotation and perform passive adduction at the knee joint and thus put stress on the LCL. OGNkMmFkZGY0YjIxNzkxN2RkOTg3YzgzMTdiYjY1OGMxMzA2NThmZjIxNGNi YjQ3NDViZGE1YWVjODEwNTIzYzIyMmY1YjViMDhhNGI3Y2YyNTI4NmMwMjli Noble J, Erat K. In defence of the meniscus: A prospective study of 200 menisectomy patients. During the maneuver, the joint line is palpated both medially and laterally. Treadmill stress tests should not be part of "routine health check YzM5MWNkYzMyMjQ0ZmU4MDdjZjg2NzYxZjhlMGI2N2RmMGI3ODExOWFmMDdl Disease paper 2 .pdf - Jade Smith BIOL 2301 Sec. 001 Inclusion in an NLM database does not imply endorsement of, or agreement with, The confidence interval (CI) attests to the precision of this estimate11. (1987) evaluated the varus stress test and found rather poor diagnostic accuracy. The accuracy of the clinical knee examination documented by arthroscopy: A prospective study. The anterior portion of the meniscus is not easily tested because the pressure to that part of the meniscus is not as great. Copyright 2018 Arthroscopy Association of North America. Each of these studies demonstrated improved diagnostic accuracy of these modified tests compared to the original McMurray's; however, they concluded that the modified tests should be used as well, as rather than as an alternative to other diagnostic tests3,5,6. The goal of the study was to evaluate 3 common manual tests (Buell, Dananberg, and Jack tests) for assessing first metatarsophalangeal joint (MPJ) mobility and determining the normal values needed to detect FHL . These authors suggested that this increase in sensitivity and specificity compared to previous studies was due to their broader definition of a positive test, i.e., reproduction of a click or pain3; however, this does not explain the similar findings of Corea et al4 in which only a click was indicative of a positive test. Further, the description of the test itself should be well explained, and improving intertester reliability in the future would increase the validity of the studies. Philadelphia: Wolters Kluwer, 2010. ZDZkZjczMGZkNzQ1OWMxZTQyNDY2ZTAzYTM5OTk2ZmQ1YjkzNDFjMDhmNzMy Sensitivity and specificity of a test. The https:// ensures that you are connecting to the MjI0NTIxNTI4MWM3YmNjNGMwMDU2Mjk4ZWM1MzcyMDNkZTAyYmNhMDljZTU1 Usually medial angulation of both femur and tibia is involved. Although these authors mentioned that the examiners were blinded to the results of the MRI, they did not make it clear if the examiners knew that there were a similar number of normals and symptomatic subjects included in the study or if they knew which group each individual subject belonged to. The results support the use of both varus stress radiographs and MRI in diagnosing FCL injuries, because MRI is more sensitive in diagnosing an acute FCL tear, and varus stress radiographs are more sensitive in diagnosing a chronic FCL tear. 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. Physical Examination of the Knee | Musculoskeletal Key Accuracy of 3 Diagnostic Tests for Anterior Cruciate Ligament Tears McMurray. This trade-off between sensitivity and specificity makes it important that they be considered jointly27. 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. Four authors stated that they used the McMurray's test but did not describe the actual testing procedure3,5,19,25. Performed at 900 of knee flexion, and has a sensitivity of 90% and a specificity of 99% Isolated PCL translate > 10-12mm in neutral and >6-8mm in internal rotation. 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. Rose NE, Gold SM. Kurosaka M, Yagi M, Yoshiya S, Muratsu H, Mizuno K. Effcacy of the axially loaded pivot shift test for the diagnosis of a meniscal tear. Studies looking at diagnostic accuracy, sensitivity and specificity have demonstrated varied values. Because they were investigating this weight-bearing test as well, the authors excluded any patients who presented within six weeks of trauma and those unable to bear weight or unable to squat. These studies have hypothesized that by incorporating aspects of varus/valgus stress and/or axial loading into the original McMurray's test, there is an increase in diagnostic value3,5,6. Towards complete and accurate reporting of studies of diagnostic accuracy: The STARD initiative. document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); We use cookies to optimize our website and our service. However, other studies have shown MRI to be no more accurate than clinical examination for the diagnosis of meniscal tears14,15. Four studies demonstrated that a positive test alters the probability to only a small, rarely important degree5,6,25, suggesting uncertainty that a positive test will indicate meniscal pathology (Table (Table5).5). ZmZjN2MzNzdhZDFlZWY2OGI0YWExNTViZjA5ZDc3OTA3MTJmYTYyOGFmMGEw Clinical diagnosis of meniscal tears: Description of a new manipulative test. However, they only included patients who had had symptoms for at least one year, making extrapolation of their findings to the acute population challenging. Saunders. When refering to evidence in academic writing, you should always try to reference the primary (original) source. MWQ3MmUzODg0NGJiYzhiODZlYmMxOGU3NzQ1ZTAwNmMxNTJjOTZiZDJlZGFi The proportion of people who do not have the disease or dysfunction who test negative. Fibular Collateral Ligament Reconstruction in Adolescent Patients. These authors considered the overall accuracy of the axially loaded pivot shift test to be higher than that of the McMurray's test (Table (Table7).7). MDYzNWEzNGQxNDFiMmU0MDBmMmJkZTU4YzNiNzE1MWYxNWM3ZGU1NzFkM2Zm Agreement regarding which articles to read in full was determined by consensus. The STARD checklist contains 25 items that help to make a judgment about potential bias in the study and appraisal of the applicability of the findings. 2008. A positive test is considered to be a thud or click that can sometimes be heard but can always be felt4 (Figure (Figure11). A comparison of accuracy between clinical examination and magnetic resonance imaging in the diagnosis of meniscal and anterior cruciate ligament tears. So, little is known about the validity of this test. Address all correspondence and requests for reprints to: Wayne Hing. Consider reproduction of pain during the test as a positive test, not just the reproduction of a. This is not surprising given the complicated nature of the technique and the difficulty in controlling the amount and direction of forces across testers. Unfortunately, it is not possible to accurately determine the precision of reliability of the Boeree and Ackroyd19 study as CIs could not be calculated. varus stress test: A test of ligament laxity, where a passive force is exerted on a joint that, in the presence of ligamentous insufficiency, would cause the lateral joint space to open, e.g., lateral collateral ligament of the knee and radial collateral ligament of the elbow. [7] It is commonly associated with other knee ligament injuries, thus LCL tear can be easily overlooked as a result of that. Clinical Rehabilitation, 22(2), 143-61. 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, YjRkMzE0ZTk0MWM3ZmIzYWU4Mjc2ZTg2NzY5MWVlZTQwNTFlM2VjN2JkOTYy Ocassionally, the LCL is congenitally absent. Douglas I, McDermott Meniscal tears. A recent meta-analysis illustrates the difference in test characteristics when performed on patients under anesthesia. Grade II: The joint space opens 3-5 mm more than the contralateral side in 20 degrees of knee flexion and less than 2 mm more than the normal knee in full extension. 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. Valgus Stress Test | Medial Collateral Ligament (MCL) Injury - Physiotutors Both (Sensitivity - Out & Specificity - In) + finding: medial or lateral joint line discomfort or have a sense of locking/catching in knee. Miller GK. 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. Kurosaka et al6 took the modification of the Medial-Lateral Grind test further by comparing the McMurray's test to a pivot shift test that not only had a component of varus/valgus stress but also included a component of axial loading. Varus stress radiographs were determined to be more sensitive in diagnosing FCL injuries compared with MRI, with an overall sensitivity of 70% compared with 66%, respectively. In most cases Physiopedia articles are a secondary source and so should not be used as references. St. Louis, MO: Saunders Elsevier;2008. IR of the tibia + Varus stress = lateral meniscus. All had persistent symptoms at least 8 weeks post-injury. An official website of the United States government. Palpation for joint line tenderness, the Apley's Grind test, and the McMurray's test are commonly used in physical therapy practice1. Applied Sciences | Free Full-Text | Comparison of Diagnostic - MDPI Fibular collateral ligament and the posterolateral corner. Confidence intervals could not be calculated32 from the data provided by these authors making it difficult to assess the accuracy of results. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. The agreed quality for each paper is included in Table Table33. IR of the tibia + Varus stress = lateral meniscus, ER of the tibia + Valgus stress = medial meniscus. This study evaluated not only the McMurray's test but also a new test (Ege's test) for meniscal pathology that is performed in a weight-bearing position. Orthopedic Physical Assessment: 5 th Edition. 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. An assessment for one-plane medial instability (gapping of the tibia away from the femur on the medial side). Higher specificity figures denote that in general when the McMurray's test is positive, it is fairly reliable for ruling in meniscal pathology. The Valgus Test of the knee is performed with the patient lies in the supine position. The Management of Sofi Tissue Knee Injuries: Internal Derangements. The technical storage or access that is used exclusively for statistical purposes. Biomechanics of musculoskeletal injury. 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. Patients who underwent arthroscopy to assess suspected meniscal or meniscal together with ACL injuries. [1]. Studies were also not examined where they clearly did not meet the search criteria. Sensitivity figures vary from 16%88%, while specificity figures vary from 20%98% (Table (Table5).5). Does the patient have a torn meniscus of ligament of the knee? Knee Sensitivity and Specificity: Flashcards | Quizlet Furthermore, the ability of both imaging modalities to identify an FCL injury was stratified based on acute versus chronic etiology. Knee, McMurray's, Meniscal, Reliability, Sensitivity, Specificity, Testing, Validity. 1. Anderson and Lipscomb5 used consecutive patients who were suspected of having a meniscal tear; however, these authors excluded subjects who had associated ligamentous injuries (as demonstrated by arthroscopy) from the statistical analysis. The site is secure. True negative: the person does not have the disease and the test is negative. The site is secure. Kane PW, Cinque ME, Moatshe G, Chahla J, DePhillipo NN, Provencher MT, LaPrade RF. followers, 277k As previously documented in the literature10, the definition and calculation of statistical measures of concurrent criterion-validity are based on the absence or agreement between the clinical test and the gold standard test. As is true of all statistics, sensitivity and specificity values are taken from a sample and represent an estimate of the true value that could be found in the population. Powell JW, Huijbregts PA. Concurrent criterion-related validity of acromioclavicular joint physical examination tests: A systematic review. The proportion of people who have the disease or dysfunction who test positive. Validity of the McMurray's Test and Modified Versions of the Test: A The four possible outcomes include true positive, a false positive, a false negative, and a true negative (see Table Table2).2). Grade III: The joint space opens 5 . Bossuyt PM, Reitsma JB, Bruns DE, et al. The test is first done with the knee in full extension and then with the knee in 20-30 degrees of flexion. FOIA Consecutive patients suspected of having meniscal tears presenting for arthroscopy: acute and chronic (ligament injuries excluded). McMurray test | Radiology Reference Article | Radiopaedia.org Varus Test | Special Tests Elbow Valgus Stress Test 2023 | OrthoFixar The statistical measures of sensitivity, specificity, and likelihood ratios were calculated from the information provided in the studies. Physical examination consisted of general elbow examination and specific examination of the distal biceps based on literature. There are several different reported methods of performing McMurrays Test, Reiders method may be the most accurate[9], Get Top Tips Tuesday and The Latest Physiopedia updates, The content on or accessible through Physiopedia is for informational purposes only. 2001;177(2):409413. 133k Based on the STARD scoring of each paper, it is possible to make a qualitative assessment about the methodological quality. The test is fairly solid. The assessment results for methodological quality has been presented under the following headings: the STARD analysis, reference standard, population differences, blinding, description and interpretation of test, inter-tester reliability, diagnostic accuracy and validity, sensitivity and specificity, likelihood ratios, and McMurray's test compared to modified versions of the test. The use of the STARD tool is also a limitation. Those that do not include consecutive patients and those that exclude different pathologies may have biased results. High specificity indicates that a test can be used for including a condition when it is positive26. The McMurray's test, as described in Corea et al4, was designed to detect tears in the posterior segment of the meniscus. 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. 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. MTk2NGZhNDE4OTk1NmViZWEyZWM3NzcwNDY0NzA4Y2VmMzBjNjI3MjUwNzdj Methods: 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 positive result at both 0 and 20 indicate cruciate ligament involvement. Corea JR, Moussa M, Al Othman A. McMurray's test tested. Electronic databases (Medline, CINhAL, AMED, SPORTSDiscus, and SCOPUS) were searched from March 1980 to May 2008.