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. Higher specificity figures denote that in general when the McMurray's test is positive, it is fairly reliable for ruling in meniscal pathology. Purpose: 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. Varus Stress Test Purpose: To assess the integrity of the LCL. Current Orthopaedics. The proportion of people who test negative and who do not have the disease or dysfunction. I concluded that joint line tenderness as a test for lateral meniscal tears is accurate (96%), sensitive (89%), and specific (97%). Arthroscopy has demonstrated an accuracy between 93% and 96%12. Interpretation: If the knee joint adducts greater than normal (compared to the unaffected leg), the test is positive. 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. 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 ). Reverse Pivot Shift Sign of Jakob, Hassler, and Stubli. Comparable sensitivity and specificity were shown in regards to the Thessaly test, 85.4% and 54%, respectively. 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. 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. YzFjZGMyZmVmOTJjNWQ2NWYyNDVkNDE1OWM3Yzg5NjE2MWNhYTY1ZGZlNGYw Further, subjects who are positive on the reference standard should reflect a continuum of severity, whereas those who are negative should have conditions commonly confused with meniscal tears17. Furthermore, the ability of both imaging modalities to identify an FCL injury was stratified based on acute versus chronic etiology. Hoppenfeld S, Hutton R, Hugh T. Physical examination of the spine and extremities. A control group was composed of patients with an MRI and intact ACL and FCL. The four possible outcomes include true positive, a false positive, a false negative, and a true negative (see Table Table2).2). Relatively narrow confidence intervals also attest to the reliability of these two studies3,4 (Table (Table55). Both imaging modalities are recommended to diagnose both acute and chronic FCL injuries. 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). Meserve BB, Cleland JA, Boucher TR. Studies were included for analysis if they compared the McMurray's test with a gold standard of knee arthroscopy or magnetic resonance imaging (MRI). ZTY2MWNjMWEzNTQ3MTc4OGU3ZWFmY2NhNWFkNDczMWFlOGI3ZDgwMTBkOGFj Churchill Livingstone, 2002. Kennedy MI, Akamefula R, DePhillipo NN, Logan CA, Peebles L, LaPrade RF. ZTE1ZTU0YzgxZTBhZGFlNGI5YzcyODQ4YjdhNTE5Yzc0MmMzMTI2YmQ5M2E1 Six of the studies within this review included consecutive patients (Table (Table4).4). Patient in supine. 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. YTY1NDM4NjNkYzAwMmMxNGU2MjgwMmMzODFlMTZkZmQyYjRmNTAzM2RkZWY4 The physiotherapist stabilize the knee with one hand, while the other hand adducts the ankle.[10]. True negative: the person does not have the disease and the test is negative. However, other studies have shown MRI to be no more accurate than clinical examination for the diagnosis of meniscal tears14,15. 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). 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. In addition, cited references of relevant articles were examined. 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. 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. Philadelphia: Wolters Kluwer, 2010. A positive test is considered to be a thud or click that can sometimes be heard but can always be felt4 (Figure (Figure11). 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. 2001;177(2):409413. How to use diagnostic test articles in the intensive care unit: Diagnosing weanability using f/Vt. ZDIwNGI3MGM0NDMzZmMxM2YxZDdmZWM0YmE5MDI5OWJiMmE4MmFhZTdkODE1 Bookshelf Each test is repeated with the knee in full extension. 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. 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 . Palpation for joint line tenderness, the Apley's Grind test, and the McMurray's test are commonly used in physical therapy practice1. 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. Posterior drawer test Posterior sag test (godfrey test) Quadriceps active test Dial test Varus/valgus stress . followers. 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. Take the leg and bring it in 30 Flexion (MLPP) and use a cushion or edge of the bed so the patient can relax. The test is fairly solid. Notes Maximum dorsiflexion locks the subtalar joint and improves the sensitivity of this test. Evans PJ, Bell GD, Frank CY. This was also discussed by Evans et al23, who attributed their low sensitivity rates to wide patient entry criteria including differing pathologies (Table (Table44). Patients identified as needing arthroscopy excluding those with intra-articular fracture, neurological or degenerative disorders. [7] It is commonly associated with other knee ligament injuries, thus LCL tear can be easily overlooked as a result of that. Published by Elsevier Inc. All rights reserved. Varus stress MRI in the refined assessment of the posterolateral corner of the knee joint. Of the four studies that demonstrated the highest shifts in probability, only Corea et al4 and Akseki et al3 contained calculable CIs, which were relatively narrow (Table (Table55). 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. When refering to evidence in academic writing, you should always try to reference the primary (original) source. Winters K, Tregonning R. Reliability of magnetic resonance imaging of the traumatic knee as determined by arthroscopy. The IR of the tibia followed by extension, the examiner can test the entire posterior horn to the middle segment of the meniscus. The remaining four studies failed to mention what denoted a positive test (Table (Table4).4). One of the search terms used was McMurray$ test$. Bearing these findings in mind, the following recommendations can be made for the clinician: This review has demonstrated that the intertester reliability and sensitivity of the McMurray's test is relatively low; however, it has also highlighted that it can be a relatively specific test, especially with respect to the lateral meniscus. 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). In extension, the posterior capsule and cruciate ligaments act as secondary restraints for varus stress. 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. Rose NE, Gold SM. (2008) A meta-analysis examining clinical test utilities for assessing meniscal injury. 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. The Heel Height Test: A Novel Tool for the Detection of Combined Anterior Cruciate Ligament and Fibular Collateral Ligament Tears. Studies of specificity and sensitivity have demonstrated varied values as a result of poor methodological quality A recent meta-analysis reports sensitivity and specificity to be 70% and 71%. 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. 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 A recent literature review on composite testing of the diagnostic tests for the meniscus reported reasonable sensitivity and specificity when the findings of a number of tests are combined31. An official website of the United States government. $ is the truncation character. Generally, the McMurray's test has relatively high specificity and low sensitivity. Sensitivity and specificity rely on a single threshold for classifying a test result as positive or negative. A wide variety of clinical tests are used to diagnose meniscal pathology within the knee joint. HHS Vulnerability Disclosure, Help Specificity: not reported. There is conflicting evidence with respect to the effect of the presence of an associated anterior cruciate ligament (ACL) deficiency. 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. Physical examination of the knee: A review of the original test description and scientific validity of common orthopedic tests. Sensitivity and specificity of this test are only 38% and 41%, respectively. Sensitivity: 25% . The McMurray's test, as described in Corea et al4, was designed to detect tears in the posterior segment of the meniscus. Pg 791. Zappia M, Capasso R, Berritto D, Maggialetti N, Varelli C, D'Agosto G, Martino MT, Carbone M, Brunese L. Musculoskelet Surg. 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. M2EwZWY0Zjg3ZDdlZTMzNDhjY2EwMzdkMmRjZmQ1M2M1OTI3ZDRiZDk0NzYx 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. 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. Once again, this affects the generalizability of the findings. Towards complete and accurate reporting of studies of diagnostic accuracy: The STARD initiative. HHS Vulnerability Disclosure, Help The agreed quality for each paper is included in Table Table33. the tibia moves away from the femur an excessive amount on the lateral aspect of the leg). Unfortunately, it is not possible to accurately determine the precision of reliability of the Boeree and Ackroyd19 study as CIs could not be calculated. 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. Manzotti A, Baiguini P, Locatelli A, et al. They commented that the lack of intertester agreement may have been due to differences in the amount of force produced. Additionally, the single photon-emission CT scan is receiving a lot . National Library of Medicine Epub 2018 Jul 27. The description should include the exact details of the test's application and the criteria used to determine positive and negative results11. The sensitivity of a test reflects the proportion of people with the disease in question who are tested positive, whereas the specificity is the proportion of those without the disease who are tested negative. TP=true positive, FP=false positive, FN=false negative, TN=true negative. 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. MWU3NjBlM2FlMDU2YWM3ODA4ZGIyZTNjODFkOWU2ZDBkMGNiYzRhZjE2MGRk 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. Based on the STARD scoring of each paper, it is possible to make a qualitative assessment about the methodological quality. Level II, case-control study. All had persistent symptoms at least 8 weeks post-injury. Those that do not include consecutive patients and those that exclude different pathologies may have biased results. YWU3NTg0YTg5NzcxMzE4M2I5NjZiYzgxNzlkYjQyNmRjYjE1OWNjZjJmNzVh Fibular Collateral Ligament Reconstruction in Adolescent Patients. Background and Objectives: Clinically, it is beneficial to determine the knee osteoarthritis (OA) subtype that responds well to conservative treatments. Orthopedic Physical Assessment: 5 th Edition. How to Perform Varus Stress Test Position of Patient: The patient should be relaxed in the supine position. Consecutive patients scheduled for menisectomy; acute and chronic. Mariani PP, Adriani E, Maresca G, Mazzola CG. Study with Quizlet and memorize flashcards containing terms like Ballottement, Valgus Stress Test, Varus Stress Test and more. However, they only included patients who had had symptoms for at least one year, making extrapolation of their findings to the acute population challenging. -----END REPORT-----. A comparison of accuracy between clinical examination and magnetic resonance imaging in the diagnosis of meniscal and anterior cruciate ligament tears. A guide to the interpretation of likelihood ratio (LR) values. Physical examination of the knee: a review of the original test description and scientific validity of common orthopedic tests. Specificity: the ability of a test to correctly identify people without the disease. 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. The https:// ensures that you are connecting to the The test is fairly solid. [1] It is one of 4 critical ligaments involved in stabilizing the knee joint. 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). Baker PE, Peckham AC, Pupparo F, Sanborn JC. McMurray. 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). Statistical evaluation of McMurray's test in the clinical diagnosis of meniscus injuries. Performance: A varus stress test is performed by stabilizing the femur and palpating the lateral joint line. That is usually the journal article where the information was first stated. As a library, NLM provides access to scientific literature. Increased Accuracy of Varus Stress Radiographs Versus Magnetic Resonance Imaging in Diagnosing Fibular Collateral Ligament Grade III Tears. An assessment for one-plane medial instability (gapping of the tibia away from the femur on the medial side). They rated the sensitivity at 25% and could not report any specificity . 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. Arthrosc Tech. In contrast, the paper by Sae-Jung et al24 found sensitivity for medial and lateral menisci of 70% and 68%, respectively, and specificity values for medial and lateral menisci of 60.7% and 47.8%, respectively. eCollection 2022 Jun. Campbell SE, Sanders TG, Morrison WB. The examiner should passively bend the affected leg to about 30 degrees of flexion. One study5 performed the test after the arthroscopy and did not state if the examiner was blinded to these results. Sensitivity: 25%. . Edinburgh: Elsevier, 2006. 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. 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. 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 examiners arm and trunk. 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. FOIA The Valgus Stress Test for LCL injuries has hardly been evaluated regarding its diagnostic accuracy. Likelihood Ratio +/-. doi: 10.1016/j.eats.2018.10.007. The varying definitions of a positive McMurray's test are also likely to have contributed to the variability of the results demonstrated by the studies reviewed. aAssociate Professor, health & Rehabilitation Research Centre, School of Rehabilitation and Occupation Studies, AUT University, Auckland, New Zealand, bSenior Lecturer, School of Rehabilitation and Occupation Studies, Auckland University of Technology, Auckland, New Zealand, cHead of School of Rehabilitation and Occupation Studies, Auckland University of Technology, Auckland, New Zealand, dSchool of Physiotherapy, Auckland University of Technology, Auckland, New Zealand. 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. So, little is known about the validity of this test. Fowler PJ, Lubliner JA. Y2RkNzAxODk3NTIxMTE2ZTkyYzE2ZjgxNmFmNWUxZGMwNmY4Mjg1ZDQ3MTkw Oberlander MA, Shalvoy RM, Hughston JC. 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.
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