M2EwZWY0Zjg3ZDdlZTMzNDhjY2EwMzdkMmRjZmQ1M2M1OTI3ZDRiZDk0NzYx Journal of Orthopaedic and Sports Physical Therapy, 37(9), 541-50. 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. 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. Cinque ME, Geeslin AG, Chahla J, Moatshe G, Pogorzelski J, DePhillipo NN, LaPrade RF. The sensitivity was 87% for the medial meniscus but only 46% for the lateral meniscus13. 13th ed. Only one study by Harilainen et al. That is usually the journal article where the information was first stated. Anderson AF, Lipscomb AB. Sensitivity and specificity values fail to do this11. This site needs JavaScript to work properly. YWU3NTg0YTg5NzcxMzE4M2I5NjZiYzgxNzlkYjQyNmRjYjE1OWNjZjJmNzVh Performance: A varus stress test is performed by stabilizing the femur and palpating the lateral joint line. [9] When LCL is injured or torn, this cordlike band is not as noticeable as on the unaffected side. 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. Meserve BB, Cleland JA, Boucher TR. Three studies in this review compared the McMurray's test to modified versions that incorporated the added components of varus/valgus stress and axial compression. Biomechanics of musculoskeletal injury. Waldman,S.D. In most cases Physiopedia articles are a secondary source and so should not be used as references. 1st ed. 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. A control group was composed of patients with an MRI and intact ACL and FCL. Normal elbow range of motion is from 0 at full extension to 140 of flexion, with a range of 30 to 130 required for Valgus instability Valgus instability arises through injuries to the MCL, specifically the AMCL. Acute knee injuries: use of decision rules for selective radiograph ordering. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). The fibular or lateral collateral ligament (LCL) is a cord-like band and acts as the primary varus stabilizer 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. MjI0NTIxNTI4MWM3YmNjNGMwMDU2Mjk4ZWM1MzcyMDNkZTAyYmNhMDljZTU1 Varus stress test video provided by Clinically Relevant, Additional tests for detecting LCL injury with other knee ligaments:[6], Get Top Tips Tuesday and The Latest Physiopedia updates, The content on or accessible through Physiopedia is for informational purposes only. Enroll in our online course: http://bit.ly/PTMSK DOWNLOAD OUR APP: iPhone/iPad: https://goo.gl/eUuF7w Android: https://goo.gl/3NKzJX GET OUR ASSESSMENT B. Zappia M, Capasso R, Berritto D, Maggialetti N, Varelli C, D'Agosto G, Martino MT, Carbone M, Brunese L. Musculoskelet Surg. OWFmOGE3YWY0OWM1ZWIzOTU5Mjg5Y2I4ODIwZmU1MmQyZWRhMmUxY2ZlMGU3 The examiner should passively bend the affected leg to about 30 degrees of flexion. The clinician hold the patient's ankle with one hand, while the other hand is on the lateral condyle of the femur. These authors also demonstrated that the Medial-Lateral Grind test had smaller (better) LR compared to the McMurray's test although the change in probability was still only small and should be considered rarely important (Table (Table77). 1, This website is powered by SportsEngine's. Careers, Unable to load your collection due to an error. Noble J, Erat K. In defence of the meniscus: A prospective study of 200 menisectomy patients. Agreement regarding which articles to read in full was determined by consensus. Limits human and English. An assessment for one-plane medial instability (gapping of the tibia away from the femur on the medial side). doi: 10.1016/j.eats.2018.10.007. 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. Those that do not include consecutive patients and those that exclude different pathologies may have biased results. The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user. 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. Painful conditions of the knee, inPain Management Vol 1.,2007. Your access to this site was blocked by Wordfence, a security provider, who protects sites from malicious activity. Acute patients (< 6 weeks) excluded. ZDM4MDExNDhjN2VjY2ExMjE4ZTQxZWUwYTUzMGUzZDcwYWYzMDA5YTYwODZh In addition, cited references of relevant articles were examined. The Valgus Stress Test for LCL injuries has hardly been evaluated regarding its diagnostic accuracy. Reid MC, Lachs MS, Feinstein AR. Studies were also not examined where they clearly did not meet the search criteria. Karachalios T, Hantes M, Zibis AH, Zachos V, Karantanas AH, Malizos KN. Specificity is the proportion of patients without the condition who have a negative test result and indicates the ability to use a test to recognize when the condition is absent11. That is usually the journal article where the information was first stated. Bethesda, MD 20894, Web Policies The remaining studies do not clearly state if their subjects were consecutive. 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. YWQ2ODI0ODM5NzE5MzVlYTlmMTRmMWEzM2NlYmU4OTViYTkwOTBmNjVjZGFj Magee, D.J Chapter 12: Knee, in Orthopedic Physical Assessment. Sensitivity, specificity, and likelihood ratios (LR) of the McMurray's test with confidence intervals (CI). There . Purpose: 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. Apply slight lateral rotation and perform passive adduction at the knee joint and thus put stress on the LCL. Yedlinsky, N.T. 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. Gursoy S, Perry AK, Dandu N, Singh H, Vadhera AS, Yanke A, LaPrade RF, Chahla J. Orthop J Sports Med. One of the tests was the valgus stress test, particularly at 30 of knee flexion. Consider reproduction of pain during the test as a positive test, not just the reproduction of a. N2IwYjAxYmE3NzM4ZmE2MTE5MTMyY2Q0M2I3NTQ5YjlkMzU3ODI3ODIyNzg0 Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Some studies have attempted to compare the diagnostic value of the McMurray's test to that of modified tests. ZTY2MWNjMWEzNTQ3MTc4OGU3ZWFmY2NhNWFkNDczMWFlOGI3ZDgwMTBkOGFj 2nd ed. Federal government websites often end in .gov or .mil. HHS Vulnerability Disclosure, Help The description of a test within a study should be sufficient to enable replication of the test by practitioners and subsequent researchers. Varus Stress Test [1] Magee DJ. Whiting WC, Zernicke RF. M2YxNmU0NGVlMWUwYjVjMDY4MzIwZjY3OTJmYTc0YzFhMDIyMDAwNTVhNGJm Hegedus EJ, Cook C, Hasselblad V, Goode A, McCrory DC. The review also highlights the idea that modified versions of the test seem to be more valid than the original version. Patients identified as needing arthroscopy excluding those with intra-articular fracture, neurological or degenerative disorders. 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). 24 General examination included carrying angle (normal, valgus,. For the varus stress test, the patient is in supine position and asked to relax. NTcwOGRhYWNmMWQyOTg0NjE1M2QwNTU5MTk0Nzk2OTQzMGU3YmUxODlhZjM0 MeSH Described a modified version (Medial-Lateral Grind test) but no description of McMurray's. The reliability of this test in extension is 68% and in 30 flexion only 56%. The best statistics for summarizing usefulness of a diagnostic test appear to be likelihood ratios (LR)17. Canada. 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. Malagelada F, Vega J, Golano P, Beynnon B, Ertem F. Knee Anatomy and Biomechanics of the Knee. The modified weight-bearing test showed a higher LR+ and a lower LR than the McMurray's test (Table (Table7).7). The .gov means its official. Fibular Collateral Ligament Reconstruction in Adolescent Patients. OThmMmM0YTcwMmQwODZhZWFkYzNjNzRlOTkzZiIsInNpZ25hdHVyZSI6IjVh Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. During the maneuver, the joint line is palpated both medially and laterally. In one of these studies, the CIs are extremely wide5. (1987) evaluated the varus stress test and found rather poor diagnostic accuracy. 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). YzQ2ZWY3MDkyMmRjMWVjYzY3ODhjNTExZjU4NGIzMTJjNjA3ZDA5Mzk3NTFl Clinical Rehabilitation, 22(2), 143-61. Useful tests should produce large shifts in probability once the result of the test is known. 2008. Sae-Jung et al24 considered pain or a clicking sound to be a positive test. The agreed quality for each paper is included in Table Table33. The reported incidence of ACL sprains and tears in the knee injuries. Malanga GA, Andrus S, Nadler SF, McLean J. 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. DOI https://doi.org/10.1016/C2009-1-59662-1. Accessibility Higher specificity figures denote that in general when the McMurray's test is positive, it is fairly reliable for ruling in meniscal pathology. YzA0Nzk1ZjQxYjY5Mzg4MWUwNDRlODM0NDRiNzZiM2I4OWVhNTQ1YmVlMDNj Then he applies a strong valgus force, with a counterforce applied at the . Six of the studies within this review included consecutive patients (Table (Table4).4). NjZjMWViMWE5MzNlMDFhOTA3YzAwYzUzODYzZmQyZGI2ODk1ZmJlOGM4YzZh How to Perform Varus Stress Test Position of Patient: The patient should be relaxed in the supine position. Performing the Test: The patient's leg should be relaxed for this test. Value of the physical examination. Clinical Diagnostic Tests Versus MRI Diagnosis of ACL Tears. An assessment for one-plane medial instability (gapping of the tibia away from the femur on the medial side). Epub 2018 Jul 27. A positive test is considered to be a thud or click that can sometimes be heard but can always be felt4 (Figure (Figure11). Medline and CINAHL search strategy via OVID. Three independent reviewers assessed each of the papers included in the review, and an overall STARD score of methodological quality was determined for each paper. Moreover, the ACL stabilizes the knee's rotation under varus or valgus stress. In total, 11 studies have been included in this critical review. Test Position: Supine. eCollection 2022 Jun. Level II, case-control study. Also described a modified version (the KKU compression-rotation test), Medial & Lateral combined = meniscal tear, Generate large and often conclusive shifts in probability, Generate small but sometimes important shifts in probability, Alter probability to a small and rarely important degree. These comments are also supported by the findings of a recent meta-analysis carried out by Hegedus et al7 and Meserve et al8. If the varus stress test is positive at 20, but negative at 0, only the LCL is torn. followers, 12k Studies that have evaluated the sensitivity and specificity of individual clinical tests to detect ligamentous injury, . 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. The accuracy measure has limited usefulness in that it does not distinguish between the diagnostic value of positive and negative results11. Diagnosis of acute knee ligament injuries: The value of stress radiography compared with clinical examination, stability, under anesthesia and arthroscopic or operative findings. Edinburgh: Elsevier, 2006. 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. With a sensitivity of 86% and a specificity of 95%, . The site is secure. 2018 Aug;46(10):2355-2365. doi: 10.1177/0363546518784301. Powell JW, Huijbregts PA. Concurrent criterion-related validity of acromioclavicular joint physical examination tests: A systematic review. 1985;13(1):14. Under the original description of the test, a thud or a click felt by the examiner (and sometimes heard) while performing the test was considered positive (McMurray as cited in Corea et al4). Philadelphia: Elsevier, 2016; 2121-2297. National Library of Medicine 4th Edition. Boeree NR, Ackroyd CE. Studies of specificity and sensitivity have demonstrated varied values as a result of poor methodological quality A recent meta-analysis reports sensitivity and specificity to be 70% and 71%. Evidence-Based Medicine: How to Practice and Teach EBM. 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. 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. Oberlander MA, Shalvoy RM, Hughston JC. Another Systematic review study by Braun Schwieterman found that the sensitivity and specificity of the medial talar tilt stress test was 50% and 88 % respectively. Campbell SE, Sanders TG, Morrison WB. A consensus method was used to discuss and resolve discrepancies between the markings of each paper between the three reviewers. Interpretation: If the knee joint adducts greater than normal (compared to the unaffected leg), the test is positive. Consecutive patients suspected of having meniscal tears presenting for arthroscopy: acute and chronic (ligament injuries excluded). Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. A recent systematic review reported a diagnostic accuracy between 56 - 84% 5.A prospective cohort study of 213 patients found poor sensitivity for medial and lateral meniscus tears of 48% and 65% respectively 6.Conversely specificity for medial and lateral meniscal tears was high, 94% . 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. The https:// ensures that you are connecting to the 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. Knee, McMurray's, Meniscal, Reliability, Sensitivity, Specificity, Testing, Validity. Consider the use of modifications of the test for improved validity. Palpation for joint line tenderness, the Apley's Grind test, and the McMurray's test are commonly used in physical therapy practice1. The statistical measures of sensitivity, specificity, and likelihood ratios were calculated from the information provided in the studies. 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. [2] Harilainen A et al. They rated the sensitivity at 25% and could not report any specificity . The McMurray's test, as described in Corea et al4, was designed to detect tears in the posterior segment of the meniscus. In addition to the database searches, personal files were hand-searched by the authors for publications and relevant material. However, in general, the CI limits are relatively narrow over all. 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. . Thus, to avoid selection bias, it is important that a study include consecutive patients with pathologies that could be commonly confused with a meniscal tear and should not include patients without symptoms. This generic search strategy was then combined with a subject-specific strategy (Table (Table1).1). MjUwZDBiZTEwYzA5YjkxZGRiYzI0YTE2MzY2ODI3ZDhjODQyYjNiZjU1YTU5 Physical examination of the knee, inThe Sports Medicine Resource Manual, Editors: Seidenberg, P.H & Beutler, A..I. 1. YjRkMzE0ZTk0MWM3ZmIzYWU4Mjc2ZTg2NzY5MWVlZTQwNTFlM2VjN2JkOTYy Physical examination consisted of general elbow examination and specific examination of the distal biceps based on literature. 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 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. and transmitted securely. ODA1ZGIwMjcwNDYzZDc3OTkwMWYwNWVkMWRlYzk1ZWExOTVhNjBiNWQ2MzUw Measures of efficacy include accuracy, sensitivity, and specificity. Sensitivity: the ability of a test to correctly identify patients with a disease. Neuromusculoskeletal examination assessment: A handbook for therapists. Fibular Collateral Ligament: Varus Stress Radiographic Analysis Using 3 Different Clinical Techniques. [2] Harilainen A. Be aware of the validity issues surrounding this test. The remaining four studies failed to mention what denoted a positive test (Table (Table4).4). Unfortunately, it is not possible to accurately determine the precision of reliability of the Boeree and Ackroyd19 study as CIs could not be calculated. Evaluation of knee instability in acute ligamentous injuries. It is important to take this into consideration when analyzing test results of studies that have used more than one examiner. followers, 277k Unauthorized use of these marks is strictly prohibited. Accuracy is the percentage of subjects who are correctly identified as either having or not having a meniscal tear. Physical examination of the knee: A review of the original test description and scientific validity of common orthopedic tests. 2008 Saunders. 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 . 76, No. The accuracy of the clinical knee examination documented by arthroscopy: A prospective study. All had persistent symptoms at least 8 weeks post-injury. [4] The popliteus tendon is deep to the LCL, seperating it from the lateral meniscus. How to appraise a diagnostic test. Disclaimer. ZTEyZjE4YTgwNjcwY2IwOWVkNmUwZDVjODFiMTExMDBhN2MyOGE5NDdhYWUz The LCL acts as a secondary stabilizer to anterior and posterior tibial translation when the cruciate ligaments are torn. Bearing these findings in mind, the following recommendations can be made for the clinician: This review has demonstrated that the intertester reliability and sensitivity of the McMurray's test is relatively low; however, it has also highlighted that it can be a relatively specific test, especially with respect to the lateral meniscus. gymnastics maple grove, annika ostle phelps, rooster teeth controversy,
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