varus stress test sensitivity and specificity varus stress test sensitivity and specificity

1173185. Fowler PJ, Lubliner JA. followers. A positive test is considered to be a thud or click that can sometimes be heard but can always be felt4 (Figure (Figure11). The knee is first in full extension, and then it is slightly (20-30 degrees) so that it is unlocked.1. Intertester reliability of clinical judgements of medial knee ligament integrity. 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. Sensitivity and specificity values fail to do this11. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. 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. Federal government websites often end in .gov or .mil. 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). Jaeschke RZ, Meade MO, Guyatt GH, Keenan SP, Cook DJ. Authors of 9 studies examined the Lachman test and reported sensitivity values ranging from 0.63-0.93 and specificity values ranging from 0.55-0.99. Careers, Unable to load your collection due to an error. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. All had persistent symptoms at least 8 weeks post-injury. Of the studies evaluated in this review, six used the original description of the McMurray's test4,6,20,2224. This is not surprising given the complicated nature of the technique and the difficulty in controlling the amount and direction of forces across testers. The description of a test within a study should be sufficient to enable replication of the test by practitioners and subsequent researchers. Baker PE, Peckham AC, Pupparo F, Sanborn JC. Future research should concentrate on building a strong methodological base incorporating large samples of consecutive patients with commonly confused pathologies. McMurrays Test - Physiopedia Whiting WC, Zernicke RF. Evaluation of Knee Instability in Acute Ligamentous Injuries. Check for excessive gapping and if you can reproduce the patients pain. Address all correspondence and requests for reprints to: Wayne Hing. . Fibular Collateral Ligament Reconstruction in Adolescent Patients. Interactive Content (Direct Video Demonstration, PubMed articles), Statistical Values for all Special Tests from the latest research, Currently on Version 6.0 Free lifetime updates. 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. Patient in supine. 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. 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. Based on MRI, overall specificity was 68%. This site needs JavaScript to work properly. [5] The LCL further splits the biceps femoris into two parts. 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. ZDIwNGI3MGM0NDMzZmMxM2YxZDdmZWM0YmE5MDI5OWJiMmE4MmFhZTdkODE1 The use of the STARD tool is also a limitation. Canada. Treadmill stress tests should not be part of "routine health check Knowledge of the diagnosis could influence the interpretation of the findings of the diagnostic test leading to an overstated diagnostic accuracy3. Sensitivity: 25%. Varus stress testing was performed in 20 of flexion, and testing in extension was not done. NWYxMjQ3NzE3ZWM2MGI5ODE2MGE0ZWZkNmNjZmQxNWM0M2JiYjFlZTJlNWQ5 and transmitted securely. Level II, case-control study. M2YxNmU0NGVlMWUwYjVjMDY4MzIwZjY3OTJmYTc0YzFhMDIyMDAwNTVhNGJm When refering to evidence in academic writing, you should always try to reference the primary (original) source. Varus stress test video provided by Clinically Relevant, Additional tests for detecting LCL injury with other knee ligaments:[6], Get Top Tips Tuesday and The Latest Physiopedia updates, The content on or accessible through Physiopedia is for informational purposes only. Schnke M, Schulte E, Schumacher U. Prometheus deel 1: Algemene anatomie en bewegingsapparaat. The importance of the valgus stress test in the diagnosis of - PubMed 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). 8600 Rockville Pike Limitations of this review relate to the search strategy used. 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. HHS Vulnerability Disclosure, Help -----BEGIN REPORT----- 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. YzZhYjViODEyOTFlYzkyIn0= The LCL acts as a secondary stabilizer to anterior and posterior tibial translation when the cruciate ligaments are torn. This generic search strategy was then combined with a subject-specific strategy (Table (Table1).1). Elbow Valgus Stress Test 2023 | OrthoFixar McMurray. That is usually the journal article where the information was first stated. Performance: A varus stress test is performed by stabilizing the femur and palpating the lateral joint line. 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. Anderson AF, Lipscomb AB. If the varus stress test is positive at 20, but negative at 0, only the LCL is torn. 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. No mention acute/chronic. Hoppenfeld S, Hutton R, Hugh T. Physical examination of the spine and extremities. (2007)Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis. When confidence intervals are not present, the CIs were incalculable due to absence of raw data. YWQ2ODI0ODM5NzE5MzVlYTlmMTRmMWEzM2NlYmU4OTViYTkwOTBmNjVjZGFj Studies by Boeree and Ackroyd19, Akseki et al3, and Karachalios et al21 demonstrated small but sometimes important shifts in probability. Epub 2017 Aug 16. 2nd ed. [3] McClure P,W et al. MR imaging of meniscal cysts: incidence, location, and clinical significance. Moreover, the ACL stabilizes the knee's rotation under varus or valgus stress. Unfortunately, it is not possible to accurately determine the precision of reliability of the Boeree and Ackroyd19 study as CIs could not be calculated. 4th Edition. One study5 performed the test after the arthroscopy and did not state if the examiner was blinded to these results. 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 ). 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. 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. An assessment for one-plane lateral instability (i.e. 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. Towards complete and accurate reporting of studies of diagnostic accuracy: The STARD initiative. Knee injuries. The final two studies20,21 limited their study population to patients suspected of meniscal injury. Patients who underwent arthroscopy to assess suspected meniscal or meniscal together with ACL injuries. The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user. In: Campbell's Operative Orthopaedics. 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. ZmFjMDhjZmYyOWRiNWU2YjhhMWNhYjFiNTU5YTI5ODM3MTY1ODYwYzc2NmFi 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. Journal of Orthopaedic and Sports Physical Therapy, 37(9), 541-50. Performing the Test: The patient's leg should be relaxed for this test. Only one study by Harilainen et al. Evans et al23 demonstrated a low level of agreement between the two examiners with intertester agreements ranging from poor for reproduction of a medial sensation (Kappa = 0.10) to fair (K = +0.38) for lateral pain. YjQ3NDViZGE1YWVjODEwNTIzYzIyMmY1YjViMDhhNGI3Y2YyNTI4NmMwMjli The accuracy measure has limited usefulness in that it does not distinguish between the diagnostic value of positive and negative results11. That is usually the journal article where the information was first stated. [8], Mechanism of injury: (for more information, see the page on LCL injuries)[4], Patient position: Legs crossed with ankle resting on opposite knee (90 knee flexion, hip abduction and external rotation). The ligament lies laterally and posteriorly along the joint line. DOI https://doi.org/10.1016/B978-1-4160-3197-0.X1000-2. (1987) evaluated the varus stress test and found rather poor diagnostic accuracy. 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. 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. The description should include the exact details of the test's application and the criteria used to determine positive and negative results11. Physical examination of the knee: A review of the original test description and scientific validity of common orthopedic tests. This was also discussed by Evans et al23, who attributed their low sensitivity rates to wide patient entry criteria including differing pathologies (Table (Table44). Disclaimer. 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). Interpretation: If the knee joint adducts greater than normal (compared to the unaffected leg), the test is positive. Lateral Collateral Ligament of the Knee - Physiopedia During the maneuver, the joint line is palpated both medially and laterally. YmRhYTcyZWFhNTQ5OTM0YWYwODRjZDU1OWU3ZjBjNmMyMjA4NTcxZTRmMDYw HHS Vulnerability Disclosure, Help 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). Unauthorized use of these marks is strictly prohibited. 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. Varus Test | Special Tests 76, No. 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. MjI0NTIxNTI4MWM3YmNjNGMwMDU2Mjk4ZWM1MzcyMDNkZTAyYmNhMDljZTU1 document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); If you want to assess the integrity of the medial collateral ligament (MCL), check out the Valgus Stress Test of the Knee. The accuracy of joint line tenderness by physical examination in the diagnosis of meniscal tears Arthroscopy. National Library of Medicine Am J Roentgenol. Examining diagnostic tests: An evidence-based perspective. Generally, the McMurray's test has relatively high specificity and low sensitivity. 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. J Sport Rehabil. YTY1NDM4NjNkYzAwMmMxNGU2MjgwMmMzODFlMTZkZmQyYjRmNTAzM2RkZWY4 High specificity indicates that a test can be used for including a condition when it is positive26. 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. H Nalwad; M Agarwal; B N Muddu; M Smith; and Mr. J K Borill (2006). (2008) A meta-analysis examining clinical test utilities for assessing meniscal injury. Careers. Your access to this site was blocked by Wordfence, a security provider, who protects sites from malicious activity. 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. The modified weight-bearing test showed a higher LR+ and a lower LR than the McMurray's test (Table (Table7).7). Four authors stated that they used the McMurray's test but did not describe the actual testing procedure3,5,19,25. Consecutive patients awaiting elective arthroscopy for suspected meniscal or other conditions based on history and physical examination. Houten: Bohn Stafleu Van Loghum, 2005. In this position the iliotibial band relaxes and makes the LCL easier to isolate. The sensitivity was 87% for the medial meniscus but only 46% for the lateral meniscus13. Six of the studies within this review included consecutive patients (Table (Table4).4). 1985;13(1):14. Palpation for joint line tenderness, the Apley's Grind test, and the McMurray's test are commonly used in physical therapy practice1. Churchill Livingstone, 2002. 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. 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. OTY4NzkyOGEwY2VjNzA3NjZiZWFkZmRlNjgyOGUwMGYxNDhkNjlhNDBhZmVi 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. Solomon DH, Simel DL, Bates DW, Katz JN, Schafter JL. ZmZjN2MzNzdhZDFlZWY2OGI0YWExNTViZjA5ZDc3OTA3MTJmYTYyOGFmMGEw 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. 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. A consensus method was used to discuss and resolve discrepancies between the markings of each paper between the three reviewers. 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. [11] Sensitivity: 25% . Miller RH, Azar FM. Cape Town: University of Cape Town, 2010. Hegedus EJ, Cook C, Hasselblad V, Goode A, McCrory DC. The accuracy of joint line tenderness by physical examination in the A 95% CI is the most commonly used and indicates a range of values within which the population value would lie with 95% certainty. OWFmOGE3YWY0OWM1ZWIzOTU5Mjg5Y2I4ODIwZmU1MmQyZWRhMmUxY2ZlMGU3 Methodological scores on the STARD (Standards for Reporting of Diagnostic Accuracy) yielded scores from 10/25 to 20/25. However, in general, the CI limits are relatively narrow over all. Although sensitivity and specificity values provide useful information, they work against the direction of clinical testing11. 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. A comparison of accuracy between clinical examination and magnetic resonance imaging in the diagnosis of meniscal and anterior cruciate ligament tears. Human Kinetics, 2008. Valgus Stress Test Increased Accuracy of Varus Stress Radiographs Versus Magnetic Resonance Imaging in Diagnosing Fibular Collateral Ligament Grade III Tears. . 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. Meserve BB, Cleland JA, Boucher TR. 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 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. The technical storage or access that is used exclusively for statistical purposes. 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%. Results: However, for medial meniscal tears, rates are lower. Knee Special Tests (Specificity & Sensitivity) Flashcards Irwig L, Tosteson AN, Gatsonis C, et al. Noble J, Erat K. In defence of the meniscus: A prospective study of 200 menisectomy patients. The Journal of Manual & Manipulative Therapy. [2] Harilainen A et al. MTk2NGZhNDE4OTk1NmViZWEyZWM3NzcwNDY0NzA4Y2VmMzBjNjI3MjUwNzdj Clipboard, Search History, and several other advanced features are temporarily unavailable. Consider the use of modifications of the test for improved validity. N2RkOWE5MGM3NmExMGZmOTNjMjczMzY5NjE2Nzk2NzllZjU0MzY5ZWM5OTE3 If the CI is wide and contains values that are not clinically important, the usefulness of the measure may be questionable11. St. Louis, MO: Saunders Elsevier;2008. Kurosaka et al6 took the modification of the Medial-Lateral Grind test further by comparing the McMurray's test to a pivot shift test that not only had a component of varus/valgus stress but also included a component of axial loading. The accuracy of the clinical knee examination documented by arthroscopy: A prospective study. They commented that the lack of intertester agreement may have been due to differences in the amount of force produced. See also: stress test Grade III: The joint space opens 5 . 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. . We hypothesized that valgus arthritic knees would respond better to conservative treatment than varus . The inclusion of patients with different pathologies would make the results of studies more generalizable to the clinical setting. ZmY3MzI2ODBmYTBhMDEzNzY3YmRkZjU0MDRhM2U2ODliZTFmOWMzYWI0MWI5 the contents by NLM or the National Institutes of Health. Specificity: the ability of a test to correctly identify people without the disease. Orthopedic Physical Assessment: 5 th Edition. Oberlander MA, Shalvoy RM, Hughston JC. 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. Saunders Elsevier. 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% . Meserve BB, Cleland JA, Boucher CT. A meta-analysis examining clinical test utilities for assessing meniscal injury. Fowler and Lubliner22 had a similarly broad population in that they included consecutive patients who warranted arthroscopic examination for any reason. Knee Sensitivity and Specificity: Flashcards | Quizlet followers, 12k Confidence intervals could not be calculated32 from the data provided by these authors making it difficult to assess the accuracy of results. Diagnosis of acute knee ligament injuries: The value of stress radiography compared with clinical examination, stability, under anesthesia and arthroscopic or operative findings. For the varus stress test, the patient is in supine position and asked to relax. 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. [1] It is one of 4 critical ligaments involved in stabilizing the knee joint. Common terms. MGQ5MzQyZWI5MjJjMjUxYjFhM2E1ZjQ5NTgzMzdmNTY4NmYwZWM1ZWQ3YTU3 The sensitivity and specificity of the McMurray's test reported in the studies identified in this review vary widely (Table (Table5).5). Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Varus Stress Test [1] Magee DJ. 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). Usually medial angulation of both femur and tibia is involved. Accuracy is the percentage of subjects who are correctly identified as either having or not having a meniscal tear. 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). Three studies used only one tester4,5,25, and two studies did not mention how many examiners were used3,24. Petty NJ. Biomechanics of musculoskeletal injury. The Valgus Stress Test for LCL injuries has hardly been evaluated regarding its diagnostic accuracy. 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). Collectively, these studies indicate that there is little consensus in the reported measures of validity of the McMurray's test and that this is mostly due to limitations in the methodological quality of the studies that were assessed. Analysis of the quality of studies that evaluate the validity and accuracy of tests, such as the McMurray's test, is difficult if key information regarding the design, conduct, and analysis of the study are not reported by the authors9. Sensitivity and specificity values infer the probability of a correct test, given the result of the reference standard11. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. Level of evidence: Each test is repeated with the knee in full extension. Test Position: Supine. 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. Cinque ME, Geeslin AG, Chahla J, Moatshe G, Pogorzelski J, DePhillipo NN, LaPrade RF. 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. Valgus Stress Test. 3rd edition. Karachalios T, Hantes M, Zibis AH, Zachos V, Karantanas AH, Malizos KN. With a sensitivity of 86% and a specificity of 95%, . Ann Chir Gynaecol. The same maneuvers are performed in gradually increasing degrees of knee flexion to progressively load more posterior segments of the menisci.