varus stress test sensitivity and specificity

Before The STARD checklist contains 25 items that help to make a judgment about potential bias in the study and appraisal of the applicability of the findings. The predictive value of Thve clinical signs in the evaluation of meniscal pathology. Orthopedic Physical Assessment: 5 th Edition. The proportion of people who test positive and who have the disease or dysfunction. 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. Original description. NCI CPTC Antibody Characterization Program. [5] The LCL further splits the biceps femoris into two parts. Petty NJ. The Heel Height Test: A Novel Tool for the Detection of Combined Anterior Cruciate Ligament and Fibular Collateral Ligament Tears. 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. Knowledge of the diagnosis could influence the interpretation of the findings of the diagnostic test leading to an overstated diagnostic accuracy3. Would you like email updates of new search results? Studies that have evaluated the sensitivity and specificity of individual clinical tests to detect ligamentous injury, . St. Louis, MO: Saunders Elsevier;2008. In one of these studies, the CIs are extremely wide5. Consecutive patients scheduled for menisectomy; acute and chronic. The inclusion of patients with different pathologies would make the results of studies more generalizable to the clinical setting. The fibular or lateral collateral ligament (LCL) is a cord-like band and acts as the primary varus stabilizer of the knee. Purpose: The varus stress test shows a lateral joint line gap. [9] When LCL is injured or torn, this cordlike band is not as noticeable as on the unaffected side. 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. Studies by Boeree and Ackroyd19, Akseki et al3, and Karachalios et al21 demonstrated small but sometimes important shifts in probability. Unable to load your collection due to an error, Unable to load your delegates due to an error. Gursoy S, Perry AK, Dandu N, Singh H, Vadhera AS, Yanke A, LaPrade RF, Chahla J. Orthop J Sports Med. Y2RkNzAxODk3NTIxMTE2ZTkyYzE2ZjgxNmFmNWUxZGMwNmY4Mjg1ZDQ3MTkw and transmitted securely. The sensitivity was 87% for the medial meniscus but only 46% for the lateral meniscus13. Apply slight lateral rotation and perform passive adduction at the knee joint and thus put stress on the LCL. NzM3NDQ2NDMzYThiNjlhNjA0M2M3MzVlMWFhYmE5ZDI3ZTI0YTIyZGIyNWM4 The physiotherapist stabilize the knee with one hand, while the other hand adducts the ankle.[10]. 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). Acute knee injuries: use of decision rules for selective radiograph ordering. When confidence intervals are not present, the CIs were incalculable due to absence of raw data. Use of methodological standards in diagnostic test research: Getting better but still not good. 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. Take the leg and bring it in 30 Flexion (MLPP) and use a cushion or edge of the bed so the patient can relax. followers, 12k Anderson AF, Lipscomb AB. 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. Conclusions: High specificity indicates that a test can be used for including a condition when it is positive26. 269-273). 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. MjI0NTIxNTI4MWM3YmNjNGMwMDU2Mjk4ZWM1MzcyMDNkZTAyYmNhMDljZTU1 Karachalios et al21 incorrectly added valgus or varus stress as a component of the McMurray's. Performance: A varus stress test is performed by stabilizing the femur and palpating the lateral joint line. 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). TP=true positive, FP=false positive, FN=false negative, TN=true negative. If the CI is wide and contains values that are not clinically important, the usefulness of the measure may be questionable11. 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. 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. Mariani PP, Adriani E, Maresca G, Mazzola CG. One study5 performed the test after the arthroscopy and did not state if the examiner was blinded to these results. 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. -----END REPORT-----. The proportion of people who have the disease or dysfunction who test positive. OTY4NzkyOGEwY2VjNzA3NjZiZWFkZmRlNjgyOGUwMGYxNDhkNjlhNDBhZmVi Sensitivity, specificity, and likelihood ratios (LR) of the McMurray's test with confidence intervals (CI). 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. MTk2NGZhNDE4OTk1NmViZWEyZWM3NzcwNDY0NzA4Y2VmMzBjNjI3MjUwNzdj The use of the STARD tool is also a limitation. 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. 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. Evidence-Based Medicine: How to Practice and Teach EBM. doi: 10.1016/j.eats.2018.10.007. The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user. Consecutive patients. Of the studies evaluated in this review, six used the original description of the McMurray's test4,6,20,2224. 5, pp. The remaining four studies failed to mention what denoted a positive test (Table (Table4).4). The test is performed at 0 and 20-30, so the knee joint is in the closed packed position. 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. 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% . Philadelphia: Elsevier, 2016; 2121-2297. . This was also discussed by Evans et al23, who attributed their low sensitivity rates to wide patient entry criteria including differing pathologies (Table (Table44). A comparison of accuracy between clinical examination and magnetic resonance imaging in the diagnosis of meniscal and anterior cruciate ligament tears. The sensitivity and specificity of the McMurray's test reported in the studies identified in this review vary widely (Table (Table5).5). They commented that the lack of intertester agreement may have been due to differences in the amount of force produced. A guide to the interpretation of likelihood ratio (LR) values. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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). Both imaging modalities are recommended to diagnose both acute and chronic FCL injuries. any of these symptoms can indicate a compromised medial or lateral meniscus. 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. 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. The IR of the tibia followed by extension, the examiner can test the entire posterior horn to the middle segment of the meniscus. Check for excessive gapping and if you can reproduce the patients pain. DOI https://doi.org/10.1016/C2009-1-59662-1. Furthermore, the ability of both imaging modalities to identify an FCL injury was stratified based on acute versus chronic etiology. 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). Careers, Unable to load your collection due to an error. Sensitivity and specificity values infer the probability of a correct test, given the result of the reference standard11. 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. 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. All had persistent symptoms at least 8 weeks post-injury. 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. 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). Diagnosis of acute knee ligament injuries: The value of stress radiography compared with clinical examination, stability, under anesthesia and arthroscopic or operative findings. ZTE1ZTU0YzgxZTBhZGFlNGI5YzcyODQ4YjdhNTE5Yzc0MmMzMTI2YmQ5M2E1 Common terms. Therefore, articles were assessed using the STARD (Standards for Reporting of Diagnostic Accuracy) checklist of methodological quality9, which uses established criteria for quality assessment of different research formats10. 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. Anterior cruciate ligament reconstruction: MR imaging findings. A positive result at both 0 and 20 indicate cruciate ligament involvement. 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). Flow diagram of literature screening process. How to use diagnostic test articles in the intensive care unit: Diagnosing weanability using f/Vt. Moore KL, Dalley AF, Agur AMR. Sensitivity and specificity of this test are only 38% and 41%, respectively. Valgus and Varus Stress Test [1] Magee DJ. Careers. Although sensitivity and specificity values provide useful information, they work against the direction of clinical testing11. [3] McClure P,W et al. Changing the threshold to increase sensitivity decreases specificity and vice versa. It has been used previously for the systematic assessment of the methodology of studies into diagnostic accuracy10. Saunders. ZTU5MGVlOWM4MDcwMGE2YmJiZjNjZTBiMjQ2N2E5OTFmNTliZDgyYzc4ZjQ0 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. Fowler and Lubliner22 had a similarly broad population in that they included consecutive patients who warranted arthroscopic examination for any reason. 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. Acute injuries excluded. Current Orthopaedics. Houten: Bohn Stafleu Van Loghum, 2005. 2018 Aug;46(10):2355-2365. doi: 10.1177/0363546518784301. Your access to this site was blocked by Wordfence, a security provider, who protects sites from malicious activity. 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. Miller RH, Azar FM. That is usually the journal article where the information was first stated. Useful tests should produce large shifts in probability once the result of the test is known. 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. Varus stress MRI in the refined assessment of the posterolateral corner of the knee joint. 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. As previously documented in the literature10, the definition and calculation of statistical measures of concurrent criterion-validity are based on the absence or agreement between the clinical test and the gold standard test. The differences in study populations are likely to have contributed to the wide variability of results across studies. ZDg0M2Q2NDY1ZmIyNjFkZjBiOWE0MzQ3ZjJhZTY1NmRmYTUwYTBiMTNkNTIz -----BEGIN REPORT----- When refering to evidence in academic writing, you should always try to reference the primary (original) source. the tibia moves away from the femur an excessive amount on the lateral aspect of the leg). Neuromusculoskeletal examination assessment: A handbook for therapists. Ocassionally, the LCL is congenitally absent. A recent meta-analysis illustrates the difference in test characteristics when performed on patients under anesthesia. Saunders Elsevier. In addition to the database searches, personal files were hand-searched by the authors for publications and relevant material. Level II, case-control study. So, little is known about the validity of this test. Sae-Jung et al24 considered pain or a clicking sound to be a positive test. 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. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). One of the search terms used was McMurray$ test$. 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. IR of the tibia + Varus stress = lateral meniscus, ER of the tibia + Valgus stress = medial meniscus. The examiner should passively bend the affected leg to about 30 degrees of flexion. Bhandari M, Guyatt GH. MjUwZDBiZTEwYzA5YjkxZGRiYzI0YTE2MzY2ODI3ZDhjODQyYjNiZjU1YTU5 Baker PE, Peckham AC, Pupparo F, Sanborn JC. 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). Fowler and Lubliner22 attributed their low sensitivity results (compared to previous studies)5,25 to population differences between the studies (Table (Table5).5). Published by Elsevier Inc. All rights reserved. No valgus or varus stress is applied. M2YxNmU0NGVlMWUwYjVjMDY4MzIwZjY3OTJmYTc0YzFhMDIyMDAwNTVhNGJm 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. Jaeschke RZ, Meade MO, Guyatt GH, Keenan SP, Cook DJ. ZDFjNGQ5ZTg3MjdkZDAxOTE5MTYxNDQ3NmIzYzNhZjE4ZjAwNDc4M2NiMzEz Other signs that have been used to denote a positive test include the production of pain, a clunk, or a pop. This is a key test to perform when assessing for posterolateral instability of the knee. Miller GK. 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. A prospective evaluation of a test for lateral meniscal tears. Sensitivity: 25%. Ann Chir Gynaecol. Statistical evaluation of McMurray's test in the clinical diagnosis of meniscus injuries. 1173185. sharing sensitive information, make sure youre on a federal 2001;177(2):409413. These studies have hypothesized that by incorporating aspects of varus/valgus stress and/or axial loading into the original McMurray's test, there is an increase in diagnostic value3,5,6. M2ZmZDZjMzRlNTA5MjMyYzZkMGVlMDJkNzM3ODllMjM3ODFmYWJhZjAwYzZh Patients identified as needing arthroscopy excluding those with intra-articular fracture, neurological or degenerative disorders. H Nalwad; M Agarwal; B N Muddu; M Smith; and Mr. J K Borill (2006). Malanga GA, Andrus S, Nadler SF, McLean J. Merriman L, Turner W. Assessment of the Lower Limb. A wide variety of clinical tests are used to diagnose meniscal pathology within the knee joint. 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. Oberlander MA, Shalvoy RM, Hughston JC. 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. Corea JR, Moussa M, Al Othman A. McMurray's test tested. HHS Vulnerability Disclosure, Help 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 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. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. HHS Vulnerability Disclosure, Help YzQ2ZWY3MDkyMmRjMWVjYzY3ODhjNTExZjU4NGIzMTJjNjA3ZDA5Mzk3NTFl Fibular Collateral Ligament: Varus Stress Radiographic Analysis Using 3 Different Clinical Techniques. Slocum Drawer Test: Inconclusive Crossover Test: Inconclusive Pivot Shift Test: Sensitivity: 60% Specificity: 96% The sensitivity of diagnosing an FCL injury based on varus stress radiographs was also determined. However, in general, the CI limits are relatively narrow over all. [8]The test has therefore often been reported to be of limited value in current clinical practice. DOI https://doi.org/10.1016/B978-1-4160-3197-0.X1000-2. FOIA The Valgus Stress Test for LCL injuries has hardly been evaluated regarding its diagnostic accuracy. The sensitivity and specificity of the clinical tests and magnetic resonance (MR) imaging are reviewed because these parameters vary, and an understanding of the diagnostic utility of both the clinical and imaging tests is important in accurately formulating a definitive diagnosis. Some of the studies did not separate the data for medial from that of lateral meniscal testing5,6,22,25. MWQ3MmUzODg0NGJiYzhiODZlYmMxOGU3NzQ1ZTAwNmMxNTJjOTZiZDJlZGFi Studies looking at diagnostic accuracy, sensitivity and specificity have demonstrated varied values. the contents by NLM or the National Institutes of Health. A positive test is considered to be a thud or click that can sometimes be heard but can always be felt4 (Figure (Figure11). 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. OGNkMmFkZGY0YjIxNzkxN2RkOTg3YzgzMTdiYjY1OGMxMzA2NThmZjIxNGNi In chronic injuries, this test has a sensitivity of 92% and a specificity of 91%, but not in acute injuries. Kennedy MI, Akamefula R, DePhillipo NN, Logan CA, Peebles L, LaPrade RF. YzA0Nzk1ZjQxYjY5Mzg4MWUwNDRlODM0NDRiNzZiM2I4OWVhNTQ1YmVlMDNj The clinician hold the patient's ankle with one hand, while the other hand is on the lateral condyle of the femur.

Arthur Kardashian Parents, How Long Does It Take For A Bird To Decompose, Friend Disagrees With Everything I Say, Articles V