Higher specificity figures denote that in general when the McMurray's test is positive, it is fairly reliable for ruling in meniscal pathology. That is usually the journal article where the information was first stated. ZDZkZjczMGZkNzQ1OWMxZTQyNDY2ZTAzYTM5OTk2ZmQ1YjkzNDFjMDhmNzMy 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. Methodology and description of the 11 studies investigating validity and clinical accuracy of McMurray's test for meniscal pathology. Evans PJ, Bell GD, Frank CY. Malanga GA, Andrus S, Nadler SF, McLean J. and transmitted securely. 1173185. NTcwOGRhYWNmMWQyOTg0NjE1M2QwNTU5MTk0Nzk2OTQzMGU3YmUxODlhZjM0 followers, 12k 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. McMurray test | Radiology Reference Article | Radiopaedia.org Usually medial angulation of both femur and tibia is involved. They also fail to take into account pre-test probability. 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. This is a key test to perform when assessing for posterolateral instability of the knee. AP and lateral radiographic images of a SE-4 fracture - ResearchGate Studies were included for analysis if they compared the McMurray's test with a gold standard of knee arthroscopy or magnetic resonance imaging (MRI). Hegedus EJ, Cook C, Hasselblad V, Goode A, McCrory DC. Specificity: the ability of a test to correctly identify people without the disease. Excluding any with past history of trauma and any with associated fractures, serious arthrosis, previous history of knee surgery or discoid meniscus identified arthroscopically. McMurrays Test - Physiopedia 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. Meserve BB, Cleland JA, Boucher TR. Conclusions: The statistical measures of sensitivity, specificity, and likelihood ratios were calculated from the information provided in the studies. sharing sensitive information, make sure youre on a federal Valgus and Varus test of the knee can be graded by the following 1: Grade I: The joint space opening is within 2 mm of the contralateral side. 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. Interpretation: If the knee joint adducts greater than normal (compared to the unaffected leg), the test is positive. 76, No. Houten: Bohn Stafleu Van Loghum, 2005. Knee injuries. FOIA Talar Tilt Test 2023 | OrthoFixar Bethesda, MD 20894, Web Policies 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). Schnke M, Schulte E, Schumacher U. Prometheus deel 1: Algemene anatomie en bewegingsapparaat. Valgus Stress Test Of The Knee 2023 | OrthoFixar 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. 8600 Rockville Pike Eleven studies met the inclusion criteria. 2017 Mar;101(Suppl 1):23-35. doi: 10.1007/s12306-017-0460-5. 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. The predictive value of Thve clinical signs in the evaluation of meniscal pathology. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. ZTE1ZTU0YzgxZTBhZGFlNGI5YzcyODQ4YjdhNTE5Yzc0MmMzMTI2YmQ5M2E1 N2RkOWE5MGM3NmExMGZmOTNjMjczMzY5NjE2Nzk2NzllZjU0MzY5ZWM5OTE3 ODFlNzFkZTQ2MDZmOTVkM2Q1MjEzNzY5YTlmZTU2MTRmYWFkYzY2ZmRmNzlj [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. [1]. Disclaimer. The remaining four studies failed to mention what denoted a positive test (Table (Table4).4). [2]Meniscal tears may occur in acute knee injuries in younger patients or as part of a degenerative process in older individuals. The technical storage or access that is used exclusively for statistical purposes. Referred from GP/A&E with suspected cruciate ligament or meniscal pathology. Karachalios et al21 incorrectly added valgus or varus stress as a component of the McMurray's. Agreement regarding which articles to read in full was determined by consensus. Increased Accuracy of Varus Stress Radiographs Versus Magnetic - PubMed In total, 11 studies have been included in this critical review. They rated the sensitivity at 25% and could not report any specificity percentage. 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. M2EwZWY0Zjg3ZDdlZTMzNDhjY2EwMzdkMmRjZmQ1M2M1OTI3ZDRiZDk0NzYx OThmMmM0YTcwMmQwODZhZWFkYzNjNzRlOTkzZiIsInNpZ25hdHVyZSI6IjVh 24 General examination included carrying angle (normal, valgus,. 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. 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. The reference lists in review articles were cross-checked and any possibility of name/term variations was queried using MEDLINE and PUBMED. Methods: 2019 Jan 21;8(2):e141-e145. Bossuyt PM, Reitsma JB, Bruns DE, et al. Orthopaedics - A guide for practitioners. Schulzer M. Diagnostic tests: A statistical review. 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). Level II, case-control study. MjUwZDBiZTEwYzA5YjkxZGRiYzI0YTE2MzY2ODI3ZDhjODQyYjNiZjU1YTU5 8600 Rockville Pike 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. Unauthorized use of these marks is strictly prohibited. ZTU5MGVlOWM4MDcwMGE2YmJiZjNjZTBiMjQ2N2E5OTFmNTliZDgyYzc4ZjQ0 Human Kinetics, 2008. A prospective evaluation of a test for lateral meniscal tears. Test (b): Disease Status test (b) results *Positive Negative Present 18 7 25 absent 2 73 75 total 20 80 100 Calculate the sensitivity, specificity, positive predictive values, and negative predictive values for each test. 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. 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. 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. Physical examination of the knee: a review of the original test description and scientific validity of common orthopedic tests. The preliminary nature of this tool also means that a more narrative review of the validity and accuracy of the tests has been presented. Sensitivity is the probability of a positive test result in someone with the pathology, whereas specificity is the probability of a negative test result in someone without the pathology.6Traditionally, tests which have high sensitivity values are able to correctly identify individuals with the pathology; thus, if the examiner obtains a negative 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). 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. NDkyMTlmYzMyYjdlN2RlZTQ2MjFiMjc5NGRhOWNjYWI3NTliM2NhYzM3YWNj followers. Am J Roentgenol. St. Louis, MO: Saunders Elsevier;2008. Posterior drawer test Posterior sag test (godfrey test) Quadriceps active test Dial test Varus/valgus stress . 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. Knee Special Tests (Specificity & Sensitivity) Flashcards A positive result at both 0 and 20 indicate cruciate ligament involvement. Knee Examination: Overview, Periprocedural Care, Technique - Medscape That is usually the journal article where the information was first stated. Review of meniscal injury and associated sports. Confidence intervals could not be calculated32 from the data provided by these authors making it difficult to assess the accuracy of results. Muellner T, Weinstabl R, Schabus R, Vecsei V, Kainberger F. The diagnosis of meniscal tears in athletes: A comparison of clinical and magnetic resonance imaging investigations. There is conflicting evidence in the literature over the accuracy of MRI. Epub 2017 Feb 14. 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. The accurate diagnosis of meniscal pathology on the basis of the findings of such tests is often difficult. 3rd edition. 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. The anterior portion of the meniscus is not easily tested because the pressure to that part of the meniscus is not as great. A comparison of accuracy between clinical examination and magnetic resonance imaging in the diagnosis of meniscal and anterior cruciate ligament tears. 2017 Dec;33(12):2177-2181. doi: 10.1016/j.arthro.2017.06.028. So, little is known about the validity of this test. Would you like email updates of new search results? Fritz JM, Wainner RS. Examining diagnostic tests: An evidence-based perspective. 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. However, for medial meniscal tears, rates are lower. 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. How to Perform Varus Stress Test Position of Patient: The patient should be relaxed in the supine position. Fibular collateral ligament and the posterolateral corner. This was also discussed by Evans et al23, who attributed their low sensitivity rates to wide patient entry criteria including differing pathologies (Table (Table44). Federal government websites often end in .gov or .mil. Both (Sensitivity - Out & Specificity - In) + finding: medial or lateral joint line discomfort or have a sense of locking/catching in knee. 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. Performance: A varus stress test is performed by stabilizing the femur and palpating the lateral joint line. In addition to the database searches, personal files were hand-searched by the authors for publications and relevant material. Diagnostic accuracy of a new clinical test (the fiessaly Test) for early detection of meniscal tears. The other hand provides a varus stress to the ankle. M2YxNmU0NGVlMWUwYjVjMDY4MzIwZjY3OTJmYTc0YzFhMDIyMDAwNTVhNGJm ZDM4MDExNDhjN2VjY2ExMjE4ZTQxZWUwYTUzMGUzZDcwYWYzMDA5YTYwODZh The acute tears frequently result from sports injuries where there is a twisting motion on the partially flexed, weight-bearing knee.[3]. 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. Canada. This generic search strategy was then combined with a subject-specific strategy (Table (Table1).1). 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. MRI has also shown to be highly reliable, but due to its expensive cost, they are less frequently used. Careers. During the maneuver, the joint line is palpated both medially and laterally. The differences in study populations are likely to have contributed to the wide variability of results across studies. Douglas I, McDermott Meniscal tears. Elbow Instability: Anatomy, Biomechanics, Diagnostic Maneuvers, and Please enable it to take advantage of the complete set of features! Patients identified as needing arthroscopy excluding those with intra-articular fracture, neurological or degenerative disorders. When confidence intervals are not present, the CIs were incalculable due to absence of raw data. Diagnosis of acute knee ligament injuries: The value of stress radiography compared with clinical examination, stability, under anesthesia and arthroscopic or operative findings. 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. A recent study by Akseki et al3 reported high combined sensitivity and specificity figures (63% and 83%, respectively) and relatively narrow confidence intervals (Table (Table5).5). 2018 Nov 1;27(6):596-600. doi: 10.1123/jsr.2016-0188. A recent evidence-based guideline for the management of acute soft tissue injuries to the knee has recommended that joint line tenderness is the only reliable clinical indicator of meniscal pathology2. 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. 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. A recent meta-analysis illustrates the difference in test characteristics when performed on patients under anesthesia. Pg 791. government site. Consecutive patients with knee pain of at least one year's duration that warranted arthroscopic investigation. Orthopedic Physical Assessment: 5 th Edition. Moreover, the ACL stabilizes the knee's rotation under varus or valgus stress. Purpose: The varus stress test shows a lateral joint line gap. Operational definitions of diagnostic accuracy terms used in the studies investigating validity of McMurray's test for meniscal pathology (modified from Powell & huijbregts10). The review suggests that modifications of the interpretation of a positive test to include reproduction of pain either as well as or on its own may enhance the validity of the test. The https:// ensures that you are connecting to the All had persistent symptoms at least 8 weeks post-injury. They rated the sensitivity at 25% and could not report any specificity . The LCL acts as a secondary stabilizer to anterior and posterior tibial translation when the cruciate ligaments are torn. Orthopedic Physical Assessment: 5 th Edition. 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. However, other studies have shown MRI to be no more accurate than clinical examination for the diagnosis of meniscal tears14,15. Anderson AF, Lipscomb AB. 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. IR of the tibia + Varus stress = lateral meniscus. Studies by Boeree and Ackroyd19, Akseki et al3, and Karachalios et al21 demonstrated small but sometimes important shifts in probability. These authors demonstrated marginally better LR+ but most interestingly, reported that their modified test (the KKU test) was 100% sensitive for lateral meniscal tears indicating that the test can be used for excluding a condition when it is negative. The reliability of this test in extension is 68% and in 30 flexion only 56%. 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. The technical storage or access that is used exclusively for anonymous statistical purposes. NzM3NDQ2NDMzYThiNjlhNjA0M2M3MzVlMWFhYmE5ZDI3ZTI0YTIyZGIyNWM4 YzA0Nzk1ZjQxYjY5Mzg4MWUwNDRlODM0NDRiNzZiM2I4OWVhNTQ1YmVlMDNj Mariani PP, Adriani E, Maresca G, Mazzola CG. I concluded that joint line tenderness as a test for lateral meniscal tears is accurate (96%), sensitive (89%), and specific (97%). A prospective study comparing the accuracy of the clinical diagnosis of meniscal tears with magnetic resonance imaging and its effect on clinical outcome. Moore KL, Dalley AF, Agur AMR. official website and that any information you provide is encrypted 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. 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. The Valgus Stress Test for LCL injuries has hardly been evaluated regarding its diagnostic accuracy. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. In testing the accuracy of a clinical test like the McMurray's test, ideally the study participants should consist of individuals who would be likely to undergo the test in clinical practice and who have a reasonable chance of having the condition16. the contents by NLM or the National Institutes of Health. Accessibility YTY1NDM4NjNkYzAwMmMxNGU2MjgwMmMzODFlMTZkZmQyYjRmNTAzM2RkZWY4 Waldman,S.D. In: DeLee & Drez's Orthopaedic Sports Medicine. InAnnales chirurgiae et gynaecologiae 1987 Jan 1 (Vol. It is primary restraint to varus rotation from 0-30 of knee flexion. The modified weight-bearing test showed a higher LR+ and a lower LR than the McMurray's test (Table (Table7).7). McMurray clearly indicated that the test that bears his name is only relevant for tears in the posterior portion of the cartilage (McMurray, 1942, cited in Corea et al4). 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). ZDFjNGQ5ZTg3MjdkZDAxOTE5MTYxNDQ3NmIzYzNhZjE4ZjAwNDc4M2NiMzEz The site is secure. Be aware of the validity issues surrounding this test. ODYyNmRjODBkYjVlYTFhN2Q3ZjEzNDRkNGI0OGNkZjQyNzhlZWM2MDE1MmQ1 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. Common terms. While some studies have stated that greater clinical experience aids correct diagnosis3,5,19, the only current statistical evidence in this regard shows no difference between an experienced and inexperienced tester 23. $ is the truncation character. The same maneuvers are performed in gradually increasing degrees of knee flexion to progressively load more posterior segments of the menisci. Arthroscopy has demonstrated an accuracy between 93% and 96%12.
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