Physical Examination of the Knee | Musculoskeletal Key A guide to the interpretation of likelihood ratio (LR) values. Sensitivity: the ability of a test to correctly identify patients with a disease. M2EwZWY0Zjg3ZDdlZTMzNDhjY2EwMzdkMmRjZmQ1M2M1OTI3ZDRiZDk0NzYx St. Louis, MO: Saunders Elsevier;2008. Although six studies used multiple testers, these did not provide statistics for reliability6,1923. The incidence of LCL injuries are relatively low (6%) when compared to other knee injuries. They commented that the lack of intertester agreement may have been due to differences in the amount of force produced. Check for excessive gapping and if you can reproduce the patients pain. ZDFjNGQ5ZTg3MjdkZDAxOTE5MTYxNDQ3NmIzYzNhZjE4ZjAwNDc4M2NiMzEz High specificity indicates that a test can be used for including a condition when it is positive26. Flow diagram of literature screening process. Jaeschke RZ, Meade MO, Guyatt GH, Keenan SP, Cook DJ. Moreover, the ACL stabilizes the knee's rotation under varus or valgus stress. Relatively narrow confidence intervals also attest to the reliability of these two studies3,4 (Table (Table55). M2ZmZDZjMzRlNTA5MjMyYzZkMGVlMDJkNzM3ODllMjM3ODFmYWJhZjAwYzZh 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. The https:// ensures that you are connecting to the A prospective evaluation of a test for lateral meniscal tears. The statistical measures of sensitivity, specificity, and likelihood ratios were calculated from the information provided in the studies. 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. The test is fairly solid. 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). Increased Accuracy of Varus Stress Radiographs Versus Magnetic Resonance Imaging in Diagnosing Fibular Collateral Ligament Grade III Tears. Unfortunately, it is not possible to accurately determine the precision of reliability of the Boeree and Ackroyd19 study as CIs could not be calculated. the tibia moves away from the femur an excessive amount on the lateral aspect of the leg). The final two studies20,21 limited their study population to patients suspected of meniscal injury. 5, pp. H Nalwad; M Agarwal; B N Muddu; M Smith; and Mr. J K Borill (2006). 2006;20:8594. official website and that any information you provide is encrypted [1]. Varus stress testing was performed in 20 of flexion, and testing in extension was not done. Studies of specificity and sensitivity have demonstrated varied values as a result of poor methodological quality[7] A recent meta-analysis reports sensitivity and specificity to be 70% and 71%. Valgus and Varus Stress Test [1] Magee DJ. A 95% CI is the most commonly used and indicates a range of values within which the population value would lie with 95% certainty. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you. In addition, cited references of relevant articles were examined. ZDZkZjczMGZkNzQ1OWMxZTQyNDY2ZTAzYTM5OTk2ZmQ1YjkzNDFjMDhmNzMy Varus Stress Test of the Knee | Lateral Collateral Ligament Injury Slocum Drawer Test: Inconclusive Crossover Test: Inconclusive Pivot Shift Test: Sensitivity: 60% Specificity: 96% Patients identified as needing arthroscopy excluding those with intra-articular fracture, neurological or degenerative disorders. any of these symptoms can indicate a compromised medial or lateral meniscus. 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). 4th ed. While it is difficult to compare results across studies due to the differences in the tests being used, the results of this review appear to show that the modified tests have higher diagnostic value than the McMurray's test. On the basis of the results of the studies in this review, it seems that intertester reliability using the McMurray's test is low. Differences in the type of tear have been suggested as influencing the result of clinical tests; however, no detailed investigation of this issue exists in the current literature3. https://www.physio-pedia.com/index.php?title=Lateral_Collateral_Ligament_of_the_Knee&oldid=221054, A direct blow to the anteromedial knee and posterolateral corner, 0: Posteriolateral capsule, arcuate-popliteus complex, anterior and posterior cruciate ligaments, lateral gastrocnemius, 20-30: Posteriolateral capsule, arcuate-popliteus complex, iliotibial band, biceps femoris tendon. Clinical Orthopedic Examination Findings in the Lower Extremity This site needs JavaScript to work properly. So, little is known about the validity of this test. Medline and CINAHL search strategy via OVID. MDU1NWE1Nzc5OGVjNTczOGU2OWUyMWYxYmY3Njk5ZTdlMDEwZTQ3MTY0Zjdm Studies were eligible for inclusion if they assessed measures of accuracy or validity of the McMurray's test or any modification of this test against a gold standard of either arthroscopy or magnetic resonance imaging (MRI) and were written in English. 2008. Elbow Instability: Anatomy, Biomechanics, Diagnostic Maneuvers, and Anterior cruciate ligament reconstruction: MR imaging findings. government site. 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. ZDM4MDExNDhjN2VjY2ExMjE4ZTQxZWUwYTUzMGUzZDcwYWYzMDA5YTYwODZh However, other studies have shown MRI to be no more accurate than clinical examination for the diagnosis of meniscal tears14,15. It is important to take this into consideration when analyzing test results of studies that have used more than one examiner. To eliminate this, the knee is held in 30 degrees of flexion. 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. Cinque ME, Geeslin AG, Chahla J, Moatshe G, Pogorzelski J, DePhillipo NN, LaPrade RF. Sensitivity and specificity of a test. How to use diagnostic test articles in the intensive care unit: Diagnosing weanability using f/Vt. The other hand provides a varus stress to the ankle. M2NhODMyZGZjNTEwMzAzY2JkMWI0MTUwM2I3NjNjN2RjYmY4NmEyNWE1ZjZk HHS Vulnerability Disclosure, Help 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. There are also discrepancies in the studies as to what constitutes a positive McMurray's test. Elsevier Health Sciences, 2014. Examining diagnostic tests: An evidence-based perspective. Zappia M, Capasso R, Berritto D, Maggialetti N, Varelli C, D'Agosto G, Martino MT, Carbone M, Brunese L. Musculoskelet Surg. Careers, Unable to load your collection due to an error. How to appraise a diagnostic test. [3] McClure P,W et al. 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. The differences in study populations are likely to have contributed to the wide variability of results across studies. Methods: Acute patients (< 6 weeks) excluded. Corea JR, Moussa M, Al Othman A. McMurray's test tested. MjUwZDBiZTEwYzA5YjkxZGRiYzI0YTE2MzY2ODI3ZDhjODQyYjNiZjU1YTU5 A prospective study comparing the accuracy of the clinical diagnosis of meniscal tears with magnetic resonance imaging and its effect on clinical outcome. With a sensitivity of 86% and a specificity of 95%, . Study with Quizlet and memorize flashcards containing terms like Ballottement, Valgus Stress Test, Varus Stress Test and more. MRI has also shown to be highly reliable, but due to its expensive cost, they are less frequently used. followers, 12k Elbow Valgus Stress Test 2023 | OrthoFixar Five studies compared modified versions of the test to McMurray's3,5,6,21,24 (Table (Table33). Performing the Test: The patient's leg should be relaxed for this test. Modified McMurray's to include valgus/varus stress. Evans PJ, Bell GD, Frank CY. Varus Test | Special Tests 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). Evaluation of Knee Instability in Acute Ligamentous Injuries. Notes Maximum dorsiflexion locks the subtalar joint and improves the sensitivity of this test. Schnke M, Schulte E, Schumacher U. Prometheus deel 1: Algemene anatomie en bewegingsapparaat. Methodological scores on the STARD (Standards for Reporting of Diagnostic Accuracy) yielded scores from 10/25 to 20/25. Elbow Varus Instability Stress TestLateral Collateral Ligament Please enable it to take advantage of the complete set of features! The reliability of this test in extension is 68% and in 30 flexion only 56%. The test has therefore often been reported to be of limited value in current clinical practice. 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. [8]The test has therefore often been reported to be of limited value in current clinical practice. Ann Chir Gynaecol. So, little is known about the validity of this test. 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). Consider the findings of this test in conjunction with those of other tests to enhance the likelihood of a correct diagnosis such as joint line tenderness. Review bias may result when the findings of the reference standard test are known by the clinicians performing the diagnostic test. 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. Of the studies evaluated in this review, six used the original description of the McMurray's test4,6,20,2224. MeSH [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. Karachalios et al21 incorrectly added valgus or varus stress as a component of the McMurray's. Varus Stress Test - The Student Physical Therapist -----BEGIN REPORT----- The Heel Height Test: A Novel Tool for the Detection of Combined Anterior Cruciate Ligament and Fibular Collateral Ligament Tears. Electronic databases (Medline, CINhAL, AMED, SPORTSDiscus, and SCOPUS) were searched from March 1980 to May 2008. 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. Based on MRI, overall specificity was 68%. Diagnosis and treatment strategies of the multiligament injured knee: a However, if positive findings are grouped with positive findings from other tests, such as joint line tenderness and Apley's test, the test may be more valid. McMurrays Test - Physiopedia 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. Clinical diagnosis of meniscal tears: Description of a new manipulative test. Sae-Jung et al24 considered pain or a clicking sound to be a positive test. Valgus Stress Test Of The Knee 2023 | OrthoFixar In: DeLee & Drez's Orthopaedic Sports Medicine. 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. An official website of the United States government. Magee, D.J Chapter 12: Knee, in Orthopedic Physical Assessment. Accuracy of 3 Diagnostic Tests for Anterior Cruciate Ligament Tears YzM5MWNkYzMyMjQ0ZmU4MDdjZjg2NzYxZjhlMGI2N2RmMGI3ODExOWFmMDdl Higher specificity figures denote that in general when the McMurray's test is positive, it is fairly reliable for ruling in meniscal pathology. Confidence intervals could not be calculated32 from the data provided by these authors making it difficult to assess the accuracy of results. This an indication of a LCL tear. Eleven studies met the inclusion criteria. N2MzZTc5OGFkMzAwZTZmM2Y1YWFiZTJjMjM3OGNkMmNkM2E4OTYzZWFkMjA5 The McMurray's test, as described in Corea et al4, was designed to detect tears in the posterior segment of the meniscus. Karachalios T, Hantes M, Zibis AH, Zachos V, Karantanas AH, Malizos KN. If the CI is wide and contains values that are not clinically important, the usefulness of the measure may be questionable11. This is a key test to perform when assessing for posterolateral instability of the knee. A positive result at both 0 and 20 indicate cruciate ligament involvement. The agreed quality for each paper is included in Table Table33. Kane PW, Cinque ME, Moatshe G, Chahla J, DePhillipo NN, Provencher MT, LaPrade RF. Partial Controlled Early Postoperative Weightbearing Versus Nonweightbearing After Reconstruction of the Fibular (Lateral) Collateral Ligament: A Randomized Controlled Trial and Equivalence Analysis. 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. Consider reproduction of pain during the test as a positive test, not just the reproduction of a. Excluding any with past history of trauma and any with associated fractures, serious arthrosis, previous history of knee surgery or discoid meniscus identified arthroscopically. The clinician hold the patient's ankle with one hand, while the other hand is on the lateral condyle of the femur. 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. 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. It has been used previously for the systematic assessment of the methodology of studies into diagnostic accuracy10. Top Contributors - Rachael Lowe, Admin, Adrian Shaji, Kim Jackson, Evan Thomas, Amanda Ager, Kai A. Sigel, Wanda van Niekerk, Tony Lowe, Tyler Shultz and WikiSysop, Meniscus tears are the most common injury of the knee. Saunders Elsevier. It is performed by placing the knee beyond 90 of flexion and then rotating the tibia on the femur into full internal rotation to test the lateral meniscus, or full external rotation to test the medial meniscus. Oberlander MA, Shalvoy RM, Hughston JC. In most cases Physiopedia articles are a secondary source and so should not be used as references. Consecutive patients scheduled for menisectomy; acute and chronic. Clinically, we do not know whether a patient has the condition before the diagnostic test (arthroscopy or MRI) is performed. 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). The test is first done with the knee in full extension and then with the knee in 20-30 degrees of flexion. Canada. Evaluation of knee instability in acute ligamentous injuries. Bhandari M, Guyatt GH. Consecutive patients suspected of having meniscal tears presenting for arthroscopy: acute and chronic (ligament injuries excluded). PDF ssslideshare.com Edinburgh: Elsevier, 2006. 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. Purpose: YzFjZGMyZmVmOTJjNWQ2NWYyNDVkNDE1OWM3Yzg5NjE2MWNhYTY1ZGZlNGYw The Journal of Manual & Manipulative Therapy. This review identified that the McMurray's test is of limited clinical value due to relatively low sensitivity, with modified tests (associated with the traditional McMurray's test) having higher diagnostic accuracy and thus these may be more useful clinically. 2022 Jun 6;10(6):23259671221100216. doi: 10.1177/23259671221100216. 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. Fibular collateral ligament and the posterolateral corner. (2008) A meta-analysis examining clinical test utilities for assessing meniscal injury. At the proximal level this ligament is closely related to the joint capsule, without having direct contact, as it is separated by fat pad, The insertion is augmented by the iliotibial band. Were the raters blinded to the results of the other test? Place the affected leg in extension and slight external rotation. 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. Manzotti A, Baiguini P, Locatelli A, et al. Manoeuvres assessing the posterolateral structures include the varus stress test, dial test, the posterolateral drawer, the external rotation recurvatum test, heel height test and the reverse pivot shift. 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. 2008 Saunders. M2YxNmU0NGVlMWUwYjVjMDY4MzIwZjY3OTJmYTc0YzFhMDIyMDAwNTVhNGJm Varus Test Of The Knee 2023 | OrthoFixar [8], Mechanism of injury: (for more information, see the page on LCL injuries)[4], Patient position: Legs crossed with ankle resting on opposite knee (90 knee flexion, hip abduction and external rotation). The therapist applies a varus stress at the knee while the ankle is stabilized. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). To some degree, this is achieved by sensitivity and specificity, which provide useful information for interpreting the results of diagnostic tests. These represent small but sometimes important shifts in probability and the stronger methodology of these studies is reflected by the relatively narrow CIs (Table (Table55). Published by Elsevier Inc. All rights reserved. Would you like email updates of new search results? Sensitivity and specificity of this test are only 38% and 41%, respectively. 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). Three studies used only one tester4,5,25, and two studies did not mention how many examiners were used3,24. Biomechanics of musculoskeletal injury. The external validity of a study is largely dependent on the study population. Walters J, editor. 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. How likely a positive test result is in people who have the disease or dysfunction as compared to how likely it is in those who do not have the disease or dysfunction. Akseki et al3 included consecutive patients with symptoms related to intra-articular knee pathology although how this was determined was not described. They rated the sensitivity at 25% and could not report any specificity . MDUwOTJiNWVjMDExNzg5OTRkYzIwNjRlYzdhZmM2MzUyYjUwY2IxYTkzMTRk The reference lists in review articles were cross-checked and any possibility of name/term variations was queried using MEDLINE and PUBMED. Physical examination tests for assessing a torn meniscus in the knee: A systematic review with meta-analysis. 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. MWQ3MmUzODg0NGJiYzhiODZlYmMxOGU3NzQ1ZTAwNmMxNTJjOTZiZDJlZGFi [1] Medial meniscus tears are generally seen more frequently than tears of the lateral meniscus, with a ratio of approximately 2:1. It is primary restraint to varus rotation from 0-30 of knee flexion. 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. Meserve BB, Cleland JA, Boucher CT. A meta-analysis examining clinical test utilities for assessing meniscal injury. 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.