varus stress test sensitivity and specificity

Interpretation: If the knee joint adducts greater than normal (compared to the unaffected leg), the test is positive. Varus Stress Test Purpose: To assess the integrity of the LCL. (PDF) Physical examination of the elbow, what is the evidence? A Edinburgh: Elsevier, 2006. 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. Based on the STARD scoring of each paper, it is possible to make a qualitative assessment about the methodological quality. The therapist applies a varus stress at the knee while the ankle is stabilized. Varus stress testing was performed in 20 of flexion, and testing in extension was not done. 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. In: DeLee & Drez's Orthopaedic Sports Medicine. Increased Accuracy of Varus Stress Radiographs Versus Magnetic Resonance Imaging in Diagnosing Fibular Collateral Ligament Grade III Tears. Douglas I, McDermott Meniscal tears. The Management of Sofi Tissue Knee Injuries: Internal Derangements. 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. -----END REPORT-----. Fibular collateral ligament and the posterolateral corner. Fibular Collateral Ligament: Varus Stress Radiographic Analysis Using 3 Different Clinical Techniques. 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). The proportion of people who test negative and who do not have the disease or dysfunction. Methodology and description of the 11 studies investigating validity and clinical accuracy of McMurray's test for meniscal pathology. Whiting WC, Zernicke RF. Karachalios T, Hantes M, Zibis AH, Zachos V, Karantanas AH, Malizos KN. 2008. 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. 4th Edition. The site is secure. 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. St. Louis, MO: Saunders Elsevier;2008. The proportion of people who have the disease or dysfunction who test positive. DOI https://doi.org/10.1016/B978-1-4160-3197-0.X1000-2. Although sensitivity and specificity values provide useful information, they work against the direction of clinical testing11. 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. . 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. Petty NJ. Rose NE, Gold SM. YjRkMzE0ZTk0MWM3ZmIzYWU4Mjc2ZTg2NzY5MWVlZTQwNTFlM2VjN2JkOTYy 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. eCollection 2022 Jun. Diagnosis and treatment strategies of the multiligament injured knee: a 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). M2YxNmU0NGVlMWUwYjVjMDY4MzIwZjY3OTJmYTc0YzFhMDIyMDAwNTVhNGJm Higher specificity figures denote that in general when the McMurray's test is positive, it is fairly reliable for ruling in meniscal pathology. Methods: Corea JR, Moussa M, Al Othman A. McMurray's test tested. sharing sensitive information, make sure youre on a federal Yedlinsky, N.T. 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. 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. Valgus Stress Test. Am J Roentgenol. Your access to this site was blocked by Wordfence, a security provider, who protects sites from malicious activity. Before 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. In general, sensitivity figures are much lower than specificity and the CI limits are wider. Slocum Drawer Test: Inconclusive Crossover Test: Inconclusive Pivot Shift Test: Sensitivity: 60% Specificity: 96% Canada. Physical examination consisted of general elbow examination and specific examination of the distal biceps based on literature. One study5 performed the test after the arthroscopy and did not state if the examiner was blinded to these results. Varus Test | Special Tests [2] Harilainen A et al. Studies looking at diagnostic accuracy, sensitivity and specificity have demonstrated varied values. 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. 2006;20:8594. The studies that compared the diagnostic accuracy of the McMurray's test with that of modified versions of the test showed enhanced diagnostic accuracy for the modified tests. Results: The proportion of people who test positive and who have the disease or dysfunction. Purpose: Original Editors - Dorien Scheirs, Joris De Pot, Top Contributors - Saimat Lachinova, Admin, Joris De Pot, Dorien Scheirs, Kim Jackson, Rachael Lowe, Leana Louw, Oyemi Sillo, WikiSysop, Tony Lowe, Derycker Andries, Naomi O'Reilly, George Prudden and Kai A. Sigel. 2018 Nov 1;27(6):596-600. doi: 10.1123/jsr.2016-0188. This lack of consensus in the literature highlights the risk that the criteria indicating a positive test can influence the test outcome, irrespective of whether the test was performed in the same manner on the same patient. 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. Sensitivity & Specificity Sensitivity: 66 % Specificity: 60 % A study on 21 patients referred with chronic medial collateral ligament injuries, the Valgus stress test at 30, 60, 70, or 90 degrees of elbow flexion was performed (The Reference Standard was Surgical visualization ). However, they only included patients who had had symptoms for at least one year, making extrapolation of their findings to the acute population challenging. M2MwN2QyM2QzMGFjZjQ3MDgzMGRiYzAyMmRlZDc3MTAxODc4MDdhNzcyZWMz 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. Level II, case-control study. Malanga GA, Andrus S, Nadler SF, McLean J. YjQ3NDViZGE1YWVjODEwNTIzYzIyMmY1YjViMDhhNGI3Y2YyNTI4NmMwMjli Conclusions: Operational definitions of diagnostic accuracy terms used in the studies investigating validity of McMurray's test for meniscal pathology (modified from Powell & huijbregts10). Fowler and Lubliner22 had a similarly broad population in that they included consecutive patients who warranted arthroscopic examination for any reason. Modified McMurray's to include valgus/varus stress. Consecutive patients clinically diagnosed as having torn menisci (based on symptoms of pain, locking, painful clicks, recurrent effusions, giving way or signs of extension block, wasting, or instability) Patients with evidence of fracture or arthritis, a previous history of surgery, or with an acute locked knee or haemarthrosis were excluded. 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. The other hand provides a varus stress to the ankle. Elsevier Health Sciences, 2014. Grade III: The joint space opens 5 . Furthermore, the ability of both imaging modalities to identify an FCL injury was stratified based on acute versus chronic etiology. The knee is first in full extension, and then it is slightly (20-30 degrees) so that it is unlocked.1. Test Position: Supine. This site needs JavaScript to work properly. The remaining four studies failed to mention what denoted a positive test (Table (Table4).4). Confidence intervals could not be calculated32 from the data provided by these authors making it difficult to assess the accuracy of results. 76, No. An assessment for one-plane medial instability (gapping of the tibia away from the femur on the medial side). Performance: A varus stress test is performed by stabilizing the femur and palpating the lateral joint line. The reported incidence of ACL sprains and tears in the knee injuries. Schnke M, Schulte E, Schumacher U. Prometheus deel 1: Algemene anatomie en bewegingsapparaat. (2008) A meta-analysis examining clinical test utilities for assessing meniscal injury. Studies were included for analysis if they compared the McMurray's test with a gold standard of knee arthroscopy or magnetic resonance imaging (MRI). If you believe Wordfence should be allowing you access to this site, please let them know using the steps below so they can investigate why this is happening. Painful conditions of the knee, inPain Management Vol 1.,2007. Epub 2017 Aug 16. document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); We use cookies to optimize our website and our service. [4] The popliteus tendon is deep to the LCL, seperating it from the lateral meniscus. [1] Medial meniscus tears are generally seen more frequently than tears of the lateral meniscus, with a ratio of approximately 2:1. 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. Epub 2018 Jul 17. Consecutive patients scheduled for menisectomy; acute and chronic. Each test is repeated with the knee in full extension. Patients identified as needing arthroscopy excluding those with intra-articular fracture, neurological or degenerative disorders. Epub 2018 Jul 27. Clipboard, Search History, and several other advanced features are temporarily unavailable. Consecutive patients suspected of having meniscal tears presenting for arthroscopy: acute and chronic (ligament injuries excluded). Noble J, Erat K. In defence of the meniscus: A prospective study of 200 menisectomy patients. 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 Changing the threshold to increase sensitivity decreases specificity and vice versa. A) AND B): The McMurray's test: Figure 1a) the tibia rotated on the femur into full internal rotation and Figure 1b) the tibia rotated on the femur into full external rotation. This is not surprising given the complicated nature of the technique and the difficulty in controlling the amount and direction of forces across testers. In total, 11 studies have been included in this critical review. Measures of efficacy include accuracy, sensitivity, and specificity. Disclaimer. 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. What are sensitivity and specificity? | Evidence-Based Nursing YzQ2ZWY3MDkyMmRjMWVjYzY3ODhjNTExZjU4NGIzMTJjNjA3ZDA5Mzk3NTFl Valgus Stress Test Baker PE, Peckham AC, Pupparo F, Sanborn JC. 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. 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). 13th ed. The differences in study populations are likely to have contributed to the wide variability of results across studies. OWFmOGE3YWY0OWM1ZWIzOTU5Mjg5Y2I4ODIwZmU1MmQyZWRhMmUxY2ZlMGU3 McMurray's test is used to determine the presence of a meniscal tear within the knee. Meserve BB, Cleland JA, Boucher TR. Reid MC, Lachs MS, Feinstein AR. Unlike the medial meniscus, which is attached to the medial ligament, the lateral meniscus is not attached to the lateral ligament. 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. Examining diagnostic tests: An evidence-based perspective. Methodological scores on the STARD (Standards for Reporting of Diagnostic Accuracy) yielded scores from 10/25 to 20/25. TP=true positive, FP=false positive, FN=false negative, TN=true negative. 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. MWQ3MmUzODg0NGJiYzhiODZlYmMxOGU3NzQ1ZTAwNmMxNTJjOTZiZDJlZGFi 24 General examination included carrying angle (normal, valgus,. 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. Moreover, the ACL stabilizes the knee's rotation under varus or valgus stress. With one hand fixate the femur. 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. government site. The technical storage or access that is used exclusively for anonymous statistical purposes. Describes clinical information available to raters, Describes statistical methods for comparing diagnostic accuracy and expressing uncertainty, Describes methods for calculating test reproducibility; if done, Reports when study was done with start and end dates for recruitment, Reports clinical and demographic characteristics of subjects, Reports how many subjects satisfying inclusion criteria did not undergo the tests; describes why these subjects were not tested, Reports time interval between researched and reference test and any treatment provided in between tests, Reports disease severity in subjects with target condition and other diagnoses in subjects without target condition, Reports cross-tabulation of researched and reference test, Reports adverse effects from researched and reference test, Reports estimates of diagnostic accuracy and measures of statistical uncertainty, Reports how indeterminate test results, missing responses, and outliers of researched test were handled, Reports estimates of variability between raters, centers, or subject subgroups; if done, Reports estimates of test reproducibility; if done, Discusses clinical applicability of study findings. The https:// ensures that you are connecting to the Evaluation of knee instability in acute ligamentous injuries. All had persistent symptoms at least 8 weeks post-injury. Knee Sensitivity and Specificity: Flashcards | Quizlet No valgus or varus stress is applied. Likelihood Ratio +/-. 2018 May 2;6(5):2325967118770170. doi: 10.1177/2325967118770170. Sensitivity figures were higher than specificity for three studies5,20,25 (Table (Table5).5). NCI CPTC Antibody Characterization Program. 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. Gursoy S, Perry AK, Dandu N, Singh H, Vadhera AS, Yanke A, LaPrade RF, Chahla J. Orthop J Sports Med. Patients suspected of having a meniscal tear on the basis of history and mechanism of injury excluding those with multiple injuries, history of knee surgery, early clinical and radiographic signs of osteoarthritis, articular cartilage injuries, neurological and musculoskeletal degenerative disorders, disorders of the synovium, acute injuries (less than 4 weeks post-trauma), and any abnormal findings on conventional radiographs. Kane PW, Cinque ME, Moatshe G, Chahla J, DePhillipo NN, Provencher MT, LaPrade RF. Value of the physical examination. government site. The site is secure. A recent study by Winters and Tregonning13 showed a diagnostic accuracy for MRI to be 90% for the medial meniscus and 82% for the lateral meniscus. 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. Valgus Stress Test Of The Knee 2023 | OrthoFixar (1987) evaluated the varus stress test and found rather poor diagnostic accuracy. The studies by Akseki et al3, Corea et al4, and Manzotti et al20 revealed negative likelihood ratios that are slightly lower than the other studies. 1, This website is powered by SportsEngine's. Accuracy is the percentage of subjects who are correctly identified as either having or not having a meniscal tear. Clinical Orthopedic Examination Findings in the Lower Extremity Based on MRI, overall specificity was 68%. [4, 6] Thessaly Test. 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. Background and Objectives: Clinically, it is beneficial to determine the knee osteoarthritis (OA) subtype that responds well to conservative treatments.
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