The other hand provides a varus stress to the ankle. ZmZjN2MzNzdhZDFlZWY2OGI0YWExNTViZjA5ZDc3OTA3MTJmYTYyOGFmMGEw 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. Based on MRI, overall specificity was 68%. 2008 Saunders. The review also highlights the idea that modified versions of the test seem to be more valid than the original version. Valgus Stress Test | Medial Collateral Ligament (MCL) Injury - Physiotutors M2YxNmU0NGVlMWUwYjVjMDY4MzIwZjY3OTJmYTc0YzFhMDIyMDAwNTVhNGJm When confidence intervals are not present, the CIs were incalculable due to absence of raw data. Slocum Drawer Test: Inconclusive Crossover Test: Inconclusive Pivot Shift Test: Sensitivity: 60% Specificity: 96% 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. 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. $ is the truncation character. [7] It is commonly associated with other knee ligament injuries, thus LCL tear can be easily overlooked as a result of that. 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. ZTE1ZTU0YzgxZTBhZGFlNGI5YzcyODQ4YjdhNTE5Yzc0MmMzMTI2YmQ5M2E1 Bossuyt PM, Reitsma JB, Bruns DE, et al. However, of those that have made this distinction, there is some consensus that the McMurray's test has higher sensitivity with respect to medial meniscal tears and higher specificity with lateral meniscal tears3,4,19,20,24. Both arthroscopy and MRI have been used as a gold standard measure for detection of meniscal injuries in knees. [12] If the varus stress test is positive at 20, but negative at 0, only the LCL is torn. 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 . In this position the iliotibial band relaxes and makes the LCL easier to isolate. Reid MC, Lachs MS, Feinstein AR. A prospective evaluation of a test for lateral meniscal tears. ODU2Y2M1MDM5YjZiZGYwM2E5ZDEyYjk5Nzc0MTA0ZWQxYmE5MmJiMjRlYWQ2 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. However, for medial meniscal tears, rates are lower. How to use diagnostic test articles in the intensive care unit: Diagnosing weanability using f/Vt. The test has therefore often been reported to be of limited value in current clinical practice. 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. A 95% CI is the most commonly used and indicates a range of values within which the population value would lie with 95% certainty. Varus stress MRI in the refined assessment of the posterolateral corner of the knee joint. An assessment for one-plane medial instability (gapping of the tibia away from the femur on the medial side). 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 authors demonstrated significantly larger (better) positive likelihood ratios and significantly smaller (better) negative likelihood ratios than the McMurray's. ZTY2MWNjMWEzNTQ3MTc4OGU3ZWFmY2NhNWFkNDczMWFlOGI3ZDgwMTBkOGFj Malanga GA, Andrus S, Nadler SF, McLean J. Hegedus EJ, Cook C, Hasselblad V, Goode A, McCrory DC. Before One of the search terms used was McMurray$ test$. government site. Both (Sensitivity - Out & Specificity - In) + finding: medial or lateral joint line discomfort or have a sense of locking/catching in knee. Were the raters blinded to the results of the other test? Intertester reliability of clinical judgements of medial knee ligament integrity. the contents by NLM or the National Institutes of Health. McMurrays test revisited: Evaluation of various methods of performing McMurrays test, Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue SUPP_II, 320. https://www.physio-pedia.com/index.php?title=McMurrays_Test&oldid=322145. Specificity: the ability of a test to correctly identify people without the disease. Varus Test | Special Tests Based on MRI, overall specificity was 68%. Saunders Elsevier. Your access to this site was blocked by Wordfence, a security provider, who protects sites from malicious activity. Download scientific diagram | AP and lateral radiographic images of a SE-4 fracture consisting of a spiral or oblique fracture laterally with a combination of an avulsion fracture medially. M2NhODMyZGZjNTEwMzAzY2JkMWI0MTUwM2I3NjNjN2RjYmY4NmEyNWE1ZjZk In most cases Physiopedia articles are a secondary source and so should not be used as references. Epub 2017 Feb 14. Additionally, the single photon-emission CT scan is receiving a lot . Sensitivity and specificity values fail to do this11. and transmitted securely. Study with Quizlet and memorize flashcards containing terms like Ballottement, Valgus Stress Test, Varus Stress Test and more. Evaluation of knee instability in acute ligamentous injuries. The modified weight-bearing test showed a higher LR+ and a lower LR than the McMurray's test (Table (Table7).7). Pg 791. An official website of the United States government. (1987) evaluated the varus stress test and found rather poor diagnostic accuracy. 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. Corea JR, Moussa M, Al Othman A. McMurray's test tested. 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. [9] When LCL is injured or torn, this cordlike band is not as noticeable as on the unaffected side. Acute patients (< 6 weeks) excluded. MjUwZDBiZTEwYzA5YjkxZGRiYzI0YTE2MzY2ODI3ZDhjODQyYjNiZjU1YTU5 The possibility of there being associated intra-articular pathology (such as anterior cruciate ligament rupture) confounds results, and the unknown validity, sensitivity, and specificity of the tests make it difficult for the clinician to be confident in making a definitive diagnosis3. PMC Varus Test Of The Knee 2023 | OrthoFixar Saunders. The predictive value of Thve clinical signs in the evaluation of meniscal pathology. OTY4NzkyOGEwY2VjNzA3NjZiZWFkZmRlNjgyOGUwMGYxNDhkNjlhNDBhZmVi 76, No. How to appraise a diagnostic test. 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). ZmY3MzI2ODBmYTBhMDEzNzY3YmRkZjU0MDRhM2U2ODliZTFmOWMzYWI0MWI5 Limiting the search to English language articles only may also have led to an omission of other relevant studies. On the basis of the results of the studies in this review, it seems that intertester reliability using the McMurray's test is low. The low sensitivity figures would indicate that in general, a negative test result is not reliable in ruling out meniscal pathology and a torn meniscus would likely be missed if the McMurray's test was the sole determinant of pathology. The remaining four studies failed to mention what denoted a positive test (Table (Table4).4). The Heel Height Test: A Novel Tool for the Detection of Combined Anterior Cruciate Ligament and Fibular Collateral Ligament Tears. 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. This means that tests rarely have both high sensitivity and specificity. All abstracts for 44 articles from Medline, 19 articles from CINAhL, 5 articles from AMED, 18 articles from SPORTSDiscus, 548 articles from SCOPUS, and 6 articles from the hand search were reviewed by the authors (Figure (Figure2).2). Flow diagram of literature screening process. Current Orthopaedics. MGY4MmExODg4MDUwZTk2NzUzNjQ0OTMxYjkxN2QwYjQ5MmMxODdmMWU4MDdi The test is fairly solid. 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. [11] Sensitivity: 25% . The inclusion of patients with different pathologies would make the results of studies more generalizable to the clinical setting. ZmFjMDhjZmYyOWRiNWU2YjhhMWNhYjFiNTU5YTI5ODM3MTY1ODYwYzc2NmFi Furthermore, the ability of both imaging modalities to identify an FCL injury was stratified based on acute versus chronic etiology. Check for excessive gapping and if you can reproduce the patients pain. official website and that any information you provide is encrypted 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% . Future research should concentrate on building a strong methodological base incorporating large samples of consecutive patients with commonly confused pathologies. 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. [4, 6] Thessaly Test. 2008. Evans et al23 concluded that examiner experience had little effect on the accuracy of the diagnosis; however, they noted that the student examiner demonstrated a significant association (p = 0.002) between the diagnosis of a medial meniscus tear and reproduction of a medial thud, while the experienced examiner demonstrated a significant association between this diagnosis and the reproduction of pain (p = 0.008) or a medial sensation (p = 0.001). 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. 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. 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. One study5 performed the test after the arthroscopy and did not state if the examiner was blinded to these results. An LR of 1 indicates that the test result does nothing to change the likelihood that the patient either does or does not have the condition, whereas the higher the LR+, the more certain you can be that a positive test indicates the person has the disorder. Published by Elsevier Inc. All rights reserved. Validity of the McMurray's Test and Modified Versions of the Test: A The accuracy of joint line tenderness by physical examination in the (2008) A meta-analysis examining clinical test utilities for assessing meniscal injury. Obviously, if the test is performed differently and/or the interpretation of a positive test is not the same, the demonstrated accuracy of the test cannot be compared. Studies looking at diagnostic accuracy, sensitivity and specificity have demonstrated varied values. Accuracy is the percentage of subjects who are correctly identified as either having or not having a meniscal tear. Results also indicate that testing for medial meniscal pathology is more sensitive than testing for lateral; however, tests for lateral meniscal pathology are more specific than tests for medial pathology3,4,19. The Valgus Test of the knee is performed with the patient lies in the supine position. 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. The ligament lies laterally and posteriorly along the joint line. Physical examination tests for assessing a torn meniscus in the knee: A systematic review with meta-analysis. 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. Y2RkNzAxODk3NTIxMTE2ZTkyYzE2ZjgxNmFmNWUxZGMwNmY4Mjg1ZDQ3MTkw 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). However, in general, the CI limits are relatively narrow over all. 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. Unauthorized use of these marks is strictly prohibited. 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. Whiting WC, Zernicke RF. YzA0Nzk1ZjQxYjY5Mzg4MWUwNDRlODM0NDRiNzZiM2I4OWVhNTQ1YmVlMDNj Then he applies a strong valgus force, with a counterforce applied at the . Douglas I, McDermott Meniscal tears. 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. 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. It is important to take this into consideration when analyzing test results of studies that have used more than one examiner. 1, This website is powered by SportsEngine's. 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. The agreed quality for each paper is included in Table Table33. The preliminary nature of this tool also means that a more narrative review of the validity and accuracy of the tests has been presented. This generic search strategy was then combined with a subject-specific strategy (Table (Table1).1). During the maneuver, the joint line is palpated both medially and laterally. 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 technical storage or access that is used exclusively for anonymous statistical purposes. This, along with the conclusions discussed above, suggests that the McMurray's test should be used as one of a combination of tests in the clinical setting3,22,23. followers. Disease paper 2 .pdf - Jade Smith BIOL 2301 Sec. 001 Fowler and Lubliner22 attributed their low sensitivity results (compared to previous studies)5,25 to population differences between the studies (Table (Table5).5). 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. If the varus stress test is positive at 20, but negative at 0, only the LCL is torn. Original description. M2MwN2QyM2QzMGFjZjQ3MDgzMGRiYzAyMmRlZDc3MTAxODc4MDdhNzcyZWMz 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). 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. The best statistics for summarizing usefulness of a diagnostic test appear to be likelihood ratios (LR)17. Karachalios T, Hantes M, Zibis AH, Zachos V, Karantanas AH, Malizos KN. The proportion of people who test positive and who have the disease or dysfunction. National Library of Medicine Noble J, Erat K. In defence of the meniscus: A prospective study of 200 menisectomy patients. 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. That is usually the journal article where the information was first stated. Therefore, this study aimed to determine the differences between varus and valgus arthritic knees in the response to conservative treatment. Electronic databases (Medline, CINhAL, AMED, SPORTSDiscus, and SCOPUS) were searched from March 1980 to May 2008. Physical examination of the knee: a review of the original test description and scientific validity of common orthopedic tests. OWFmOGE3YWY0OWM1ZWIzOTU5Mjg5Y2I4ODIwZmU1MmQyZWRhMmUxY2ZlMGU3 Evans PJ, Bell GD, Frank CY. Six of the studies within this review included consecutive patients (Table (Table4).4). Ciba M, Winkelmeyer EM, Schock J, Westfechtel S, Nolte T, Knobe M, Prescher A, Kuhl C, Truhn D, Nebelung S. Sci Rep. 2022 Jul 13;12(1):11858. doi: 10.1038/s41598-022-15787-2. Fowler PJ, Lubliner JA. Described a modified version (Medial-Lateral Grind test) but no description of McMurray's. Generally, the McMurray's test has relatively high specificity and low sensitivity. 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. Although six studies used multiple testers, these did not provide statistics for reliability6,1923. FOIA Similarly, Corea et al4 included consecutive patients who were clinically diagnosed as having torn menisci based on a number of signs and symptoms including locking, a positive McMurray's test, painful clicks, and giving way. Campbell SE, Sanders TG, Morrison WB. The majority of studies did not report intertester or intratester reliability of the McMurray's test. 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. Physical Examination of the Knee | Musculoskeletal Key Elbow Varus Instability Stress TestLateral Collateral Ligament Consider reproduction of pain during the test as a positive test, not just the reproduction of a. The Management of Sofi Tissue Knee Injuries: Internal Derangements. The McMurray's test, as described in Corea et al4, was designed to detect tears in the posterior segment of the meniscus. I concluded that joint line tenderness as a test for lateral meniscal tears is accurate (96%), sensitive (89%), and specific (97%). any of these symptoms can indicate a compromised medial or lateral meniscus. 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. NCI CPTC Antibody Characterization Program. Ocassionally, the LCL is congenitally absent. The proportion of people who test negative and who do not have the disease or dysfunction. Miller GK. Generated by Wordfence at Mon, 1 May 2023 20:49:59 GMT.Your computer's time: document.write(new Date().toUTCString());. These authors excluded subjects with clinical or radiographic evidence of arthritis or fracture that would increase the accuracy of testing but decrease the generalizability of the findings.