varus stress test sensitivity and specificity

The proportion of people who do not have the disease or dysfunction who test negative. 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. 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. [5] The LCL further splits the biceps femoris into two parts. McMurrays Test - Physiopedia Modified McMurray's to include valgus/varus stress. official website and that any information you provide is encrypted 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. 2nd ed. This is a relatively new tool and has not been subjected to an analysis of its reliability at this time; however, the tool does provide a consistent framework on which to base the analysis of diagnostic studies. Measures of efficacy include accuracy, sensitivity, and specificity. 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). Fowler and Lubliner22 attributed their low sensitivity results (compared to previous studies)5,25 to population differences between the studies (Table (Table5).5). Neuromusculoskeletal examination assessment: A handbook for therapists. However, for medial meniscal tears, rates are lower. 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. PDF ssslideshare.com A recent meta-analysis illustrates the difference in test characteristics when performed on patients under anesthesia. MGQ5MzQyZWI5MjJjMjUxYjFhM2E1ZjQ5NTgzMzdmNTY4NmYwZWM1ZWQ3YTU3 Failure to do this makes it difficult to determine if the findings of the study can be compared to other studies that have evaluated the same test. Reliability Study of Diagnostic Tests for Functional Hallux Limitus 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. 133k Acute injuries excluded. The Diagnostic Accuracy of Clinical Tests for Stress Fractures Valgus and Varus Stress Test - Physical Therapy Haven YzM5MWNkYzMyMjQ0ZmU4MDdjZjg2NzYxZjhlMGI2N2RmMGI3ODExOWFmMDdl This was also discussed by Evans et al23, who attributed their low sensitivity rates to wide patient entry criteria including differing pathologies (Table (Table44). 2006;20:8594. 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. There are also discrepancies in the studies as to what constitutes a positive McMurray's test. Meserve BB, Cleland JA, Boucher TR. sharing sensitive information, make sure youre on a federal Conclusions: (PDF) Physical examination of the elbow, what is the evidence? A This is a key test to perform when assessing for posterolateral instability of the knee. 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. Bhandari M, Guyatt GH. Journal of Orthopaedic and Sports Physical Therapy, 37(9), 541-50. Use of methodological standards in diagnostic test research: Getting better but still not good. ZmNhYzI5Njc5MTEwZGU2NTAzYmRjNmJiODlmMmU0N2FhYzFhMDRjNjQ1YTNk eyJtZXNzYWdlIjoiMDAzMWIwNTU1ZDk0ZjIzMGU1NDkwYzhmOWYxZTk0YWI3 They commented that the lack of intertester agreement may have been due to differences in the amount of force produced. No valgus or varus stress is applied. Apply slight lateral rotation and perform passive adduction at the knee joint and thus put stress on the LCL. 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. ZDM4MDExNDhjN2VjY2ExMjE4ZTQxZWUwYTUzMGUzZDcwYWYzMDA5YTYwODZh 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. Pg 791. Comparison of likelihood ratio's for McMurray's test with modified tests. 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. 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 . 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. Waldman,S.D. 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. Fowler and Lubliner22 had a similarly broad population in that they included consecutive patients who warranted arthroscopic examination for any reason. That is usually the journal article where the information was first stated. 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. The remaining studies do not clearly state if their subjects were consecutive. Once again, this affects the generalizability of the findings. Described a modified version (Ege's test) but no description of McMurray's. Accessibility Usually medial angulation of both femur and tibia is involved. Fibular collateral ligament and the posterolateral corner. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. Changing the threshold to increase sensitivity decreases specificity and vice versa. [4] The popliteus tendon is deep to the LCL, seperating it from the lateral meniscus. In order to make the retrieval of articles as comprehensive as possible, a generic search strategy was employed using Medline, CINAhL, and AMED databases through OVID, SPORTDiscus database through EBSCO, and SCOPUS, from 1980 to May 2008. Fibular Collateral Ligament: Varus Stress Radiographic Analysis Using 3 Different Clinical Techniques. Review bias may result when the findings of the reference standard test are known by the clinicians performing the diagnostic test. Blinding of the clinicians from the results of the diagnostic test was either not mentioned or not performed in all of the studies in this review except for the study by Karachalios et al21. Increased Accuracy of Varus Stress Radiographs Versus Magnetic - PubMed The Journal of Manual & Manipulative Therapy. Sensitivity and specificity rely on a single threshold for classifying a test result as positive or negative. Gursoy S, Perry AK, Dandu N, Singh H, Vadhera AS, Yanke A, LaPrade RF, Chahla J. Orthop J Sports Med. Diagnosis and treatment strategies of the multiligament injured knee: a Solomon DH, Simel DL, Bates DW, Katz JN, Schafter JL. AP and lateral radiographic images of a SE-4 fracture - ResearchGate Varus Stress Test of the Knee | Lateral Collateral Ligament Test The modified weight-bearing test showed a higher LR+ and a lower LR than the McMurray's test (Table (Table7).7). An LR+ indicates the degree of certainty that a patient with a positive test actually has the suspected condition while an LR indicates the degree of certainty that a patient with a negative test does not have the suspected condition27. Relatively narrow confidence intervals also attest to the reliability of these two studies3,4 (Table (Table55). Studies of specificity and sensitivity have demonstrated varied values as a result of poor methodological quality[7] A recent meta-analysis reports sensitivity and specificity to be 70% and 71%. 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. followers. The anterior portion of the meniscus is not easily tested because the pressure to that part of the meniscus is not as great. 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. This means that tests rarely have both high sensitivity and specificity. The .gov means its official. When confidence intervals are not present, the CIs were incalculable due to absence of raw data. Varus Test Of The Knee 2023 | OrthoFixar 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. [11] Sensitivity: 25% . 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. 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. eCollection 2019 Feb. M2EwZWY0Zjg3ZDdlZTMzNDhjY2EwMzdkMmRjZmQ1M2M1OTI3ZDRiZDk0NzYx Statistical evaluation of McMurray's test in the clinical diagnosis of meniscus injuries. The reported incidence of ACL sprains and tears in the knee injuries. The .gov means its official. Eleven studies met the inclusion criteria. Knee, McMurray's, Meniscal, Reliability, Sensitivity, Specificity, Testing, Validity. Elbow Varus Instability Stress TestLateral Collateral Ligament This trade-off between sensitivity and specificity makes it important that they be considered jointly27. DOI https://doi.org/10.1016/C2009-1-59662-1. Knowledge of the diagnosis could influence the interpretation of the findings of the diagnostic test leading to an overstated diagnostic accuracy3. Epub 2017 Aug 16. Of the studies evaluated in this review, six used the original description of the McMurray's test4,6,20,2224. M2MwN2QyM2QzMGFjZjQ3MDgzMGRiYzAyMmRlZDc3MTAxODc4MDdhNzcyZWMz Boeree NR, Ackroyd CE. IR of the tibia + Varus stress = lateral meniscus, ER of the tibia + Valgus stress = medial meniscus. Karachalios T, Hantes M, Zibis AH, Zachos V, Karantanas AH, Malizos KN. To some degree, this is achieved by sensitivity and specificity, which provide useful information for interpreting the results of diagnostic tests. 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). Rose NE, Gold SM. Take the leg and bring it in 30 Flexion (MLPP) and use a cushion or edge of the bed so the patient can relax. When refering to evidence in academic writing, you should always try to reference the primary (original) source. Bethesda, MD 20894, Web Policies Be aware of the validity issues surrounding this test. Methodology and description of the 11 studies investigating validity and clinical accuracy of McMurray's test for meniscal pathology. National Library of Medicine Philadelphia: Wolters Kluwer, 2010. 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 inclusion of patients with multiple pathologies is likely to lessen the diagnostic accuracy of a test; however, this would reflect actual clinical practice6,18. [1] The therapist applies a valgus stress at the knee while the ankle is stabilized in slight lateral rotation either with the hand or with the leg held between the examiner's arm and trunk. Three of these studies had fairly broad inclusion criteria that better reflect the population seen in clinical practice with two including subjects with suspected meniscal or ligamentous pathology6,19; the study by Sae-jung et al24 included any patients identified as needing arthroscopy. Electronic databases (Medline, CINhAL, AMED, SPORTSDiscus, and SCOPUS) were searched from March 1980 to May 2008. 2nd ed. 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. 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. This is not surprising given the complicated nature of the technique and the difficulty in controlling the amount and direction of forces across testers. Only one study by Harilainen et al. Schnke M, Schulte E, Schumacher U. Prometheus deel 1: Algemene anatomie en bewegingsapparaat. In an analysis of 20 available studies, the mean sensitivity and specificity of the anterior drawer test were 38% to 81% in awake patients and 63% to 91% in anesthetized patients, respectively. 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. Cape Town: University of Cape Town, 2010. One study5 performed the test after the arthroscopy and did not state if the examiner was blinded to these results. Operational definitions of diagnostic accuracy terms used in the studies investigating validity of McMurray's test for meniscal pathology (modified from Powell & huijbregts10). These comments are also supported by the findings of a recent meta-analysis carried out by Hegedus et al7 and Meserve et al8. Treadmill stress tests should not be part of "routine health check -----END REPORT-----. Epub 2017 Feb 14. Bethesda, MD 20894, Web Policies 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. Unlike the medial meniscus, which is attached to the medial ligament, the lateral meniscus is not attached to the lateral ligament. [2]Meniscal tears may occur in acute knee injuries in younger patients or as part of a degenerative process in older individuals. Federal government websites often end in .gov or .mil. Consequently, it is likely that the accuracy of meniscal testing demonstrated by this study is artificially high compared to studies with a wider inclusion criteria. Then he applies a strong valgus force, with a counterforce applied at the . The test is fairly solid. 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. Before [4, 6] Thessaly Test. 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. During the maneuver, the joint line is palpated both medially and laterally. YjQ3NDViZGE1YWVjODEwNTIzYzIyMmY1YjViMDhhNGI3Y2YyNTI4NmMwMjli Examining diagnostic tests: An evidence-based perspective. 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. Five studies compared modified versions of the test to McMurray's3,5,6,21,24 (Table (Table33). IR of the tibia + Varus stress = lateral meniscus. Sensitivity and specificity of this test are only 38% and 41%, respectively. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Elbow Instability: Anatomy, Biomechanics, Diagnostic Maneuvers, and Consider the use of modifications of the test for improved validity. Y2RkNzAxODk3NTIxMTE2ZTkyYzE2ZjgxNmFmNWUxZGMwNmY4Mjg1ZDQ3MTkw Agreement regarding which articles to read in full was determined by consensus. (2008) A meta-analysis examining clinical test utilities for assessing meniscal injury. ZTY2MWNjMWEzNTQ3MTc4OGU3ZWFmY2NhNWFkNDczMWFlOGI3ZDgwMTBkOGFj

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