varus stress test sensitivity and specificity

MDUwOTJiNWVjMDExNzg5OTRkYzIwNjRlYzdhZmM2MzUyYjUwY2IxYTkzMTRk The description of a test within a study should be sufficient to enable replication of the test by practitioners and subsequent researchers. Varus stress MRI in the refined assessment of the posterolateral corner of the knee joint. Patients who underwent arthroscopy to assess suspected meniscal or meniscal together with ACL injuries. Study with Quizlet and memorize flashcards containing terms like Ballottement, Valgus Stress Test, Varus Stress Test and more. 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. 76, No. Fowler and Lubliner22 attributed their low sensitivity results (compared to previous studies)5,25 to population differences between the studies (Table (Table5).5). 2001;177(2):409413. YWQ2ODI0ODM5NzE5MzVlYTlmMTRmMWEzM2NlYmU4OTViYTkwOTBmNjVjZGFj In this position the iliotibial band relaxes and makes the LCL easier to isolate. 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. Whiting WC, Zernicke RF. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. 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. ZDFjNGQ5ZTg3MjdkZDAxOTE5MTYxNDQ3NmIzYzNhZjE4ZjAwNDc4M2NiMzEz True negative: the person does not have the disease and the test is negative. 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. 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. 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. [12] If the varus stress test is positive at 20, but negative at 0, only the LCL is torn. In: Campbell's Operative Orthopaedics. Of the studies evaluated in this review, six used the original description of the McMurray's test4,6,20,2224. No valgus or varus stress is applied. Examining diagnostic tests: An evidence-based perspective. Bossuyt PM, Reitsma JB, Bruns DE, et al. The test has therefore often been reported to be of limited value in current clinical practice. Comparable sensitivity and specificity were shown in regards to the Thessaly test, 85.4% and 54%, respectively. (2008) A meta-analysis examining clinical test utilities for assessing meniscal injury. The reference lists in review articles were cross-checked and any possibility of name/term variations was queried using MEDLINE and PUBMED. ZTEyZjE4YTgwNjcwY2IwOWVkNmUwZDVjODFiMTExMDBhN2MyOGE5NDdhYWUz 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. 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. followers, 712k Evans et al23 used consecutive patients on a waiting list for arthroscopy for a variety of conditions including, but not limited to, suspected meniscal tears. 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. Neuromusculoskeletal examination assessment: A handbook for therapists. NWI4Njg2Y2FiM2QzZGFjNjA2MjRhYTcxMTY2NmVkZmYzNTMwZDdiNTk4YTcy Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you. 2008. YzFjZGMyZmVmOTJjNWQ2NWYyNDVkNDE1OWM3Yzg5NjE2MWNhYTY1ZGZlNGYw 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. and transmitted securely. Accuracy is the percentage of subjects who are correctly identified as either having or not having a meniscal tear. 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). Powell JW, Huijbregts PA. Concurrent criterion-related validity of acromioclavicular joint physical examination tests: A systematic review. The same maneuvers are performed in gradually increasing degrees of knee flexion to progressively load more posterior segments of the menisci. 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. YjRkMzE0ZTk0MWM3ZmIzYWU4Mjc2ZTg2NzY5MWVlZTQwNTFlM2VjN2JkOTYy A wide variety of clinical tests are used to diagnose meniscal pathology within the knee joint. 2018 Nov 1;27(6):596-600. doi: 10.1123/jsr.2016-0188. 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. Both imaging modalities are recommended to diagnose both acute and chronic FCL injuries. Accessibility 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. 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. We hypothesized that valgus arthritic knees would respond better to conservative treatment than varus . 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. Excluding any with past history of trauma and any with associated fractures, serious arthrosis, previous history of knee surgery or discoid meniscus identified arthroscopically. 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. 2018 Aug;46(10):2355-2365. doi: 10.1177/0363546518784301. Acute injuries excluded. YTY1NDM4NjNkYzAwMmMxNGU2MjgwMmMzODFlMTZkZmQyYjRmNTAzM2RkZWY4 followers, 12k ODFlNzFkZTQ2MDZmOTVkM2Q1MjEzNzY5YTlmZTU2MTRmYWFkYzY2ZmRmNzlj Level II, case-control study. Methodology and description of the 11 studies investigating validity and clinical accuracy of McMurray's test for meniscal pathology. Some of the studies did not separate the data for medial from that of lateral meniscal testing5,6,22,25. The IR of the tibia followed by extension, the examiner can test the entire posterior horn to the middle segment of the meniscus. The examiner should passively bend the affected leg to about 30 degrees of flexion. It seems logical that those studies that include both pain and a click should have higher diagnostic value as compared to studies that just use one sign or the other. 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. The remaining studies do not clearly state if their subjects were consecutive. 2017 Dec;33(12):2177-2181. doi: 10.1016/j.arthro.2017.06.028. This means that tests rarely have both high sensitivity and specificity. Fowler PJ, Lubliner JA. M2ZmZDZjMzRlNTA5MjMyYzZkMGVlMDJkNzM3ODllMjM3ODFmYWJhZjAwYzZh 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. 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. The proportion of people who have the disease or dysfunction who test positive. N2MzZTc5OGFkMzAwZTZmM2Y1YWFiZTJjMjM3OGNkMmNkM2E4OTYzZWFkMjA5 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. The .gov means its official. 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. Clinial oriented anatomy. 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. Sensitivity and specificity values infer the probability of a correct test, given the result of the reference standard11. 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. Simmel DL, Samsa GP, Matchar DB. 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. 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. Meserve BB, Cleland JA, Boucher CT. A meta-analysis examining clinical test utilities for assessing meniscal injury. Canada. Baker PE, Peckham AC, Pupparo F, Sanborn JC. 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. [1] It is one of 4 critical ligaments involved in stabilizing the knee joint. The fibular or lateral collateral ligament (LCL) is a cord-like band and acts as the primary varus stabilizer of the knee. Six of the studies within this review included consecutive patients (Table (Table4).4). Higher specificity figures denote that in general when the McMurray's test is positive, it is fairly reliable for ruling in meniscal pathology. Other signs that have been used to denote a positive test include the production of pain, a clunk, or a pop. Guidelines for meta-analyses evaluating diagnostic tests. Published by Elsevier Inc. All rights reserved. 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. Sensitivity: the ability of a test to correctly identify patients with a disease. The incidence of LCL injuries are relatively low (6%) when compared to other knee injuries. 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. ZmY3MzI2ODBmYTBhMDEzNzY3YmRkZjU0MDRhM2U2ODliZTFmOWMzYWI0MWI5 Specificity: not reported. Kennedy MI, Akamefula R, DePhillipo NN, Logan CA, Peebles L, LaPrade RF. The https:// ensures that you are connecting to the Pg 791. 1985;13(1):14. Irwig L, Tosteson AN, Gatsonis C, et al. Some studies have attempted to compare the diagnostic value of the McMurray's test to that of modified tests. Assessment of the menisci and cruciate ligaments: An audit of clinical practice. Copyright 2018 Arthroscopy Association of North America. In addition to the database searches, personal files were hand-searched by the authors for publications and relevant material. Varus Stress Test [1] Magee DJ. Epub 2017 Aug 16. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. During the maneuver, the joint line is palpated both medially and laterally. True positive: the person has the disease and the test is positive. Before Use of methodological standards in diagnostic test research: Getting better but still not good. 2019 Jan 21;8(2):e141-e145. Evaluation of knee instability in acute ligamentous injuries. Level of evidence: ZDg0M2Q2NDY1ZmIyNjFkZjBiOWE0MzQ3ZjJhZTY1NmRmYTUwYTBiMTNkNTIz YzQ2ZWY3MDkyMmRjMWVjYzY3ODhjNTExZjU4NGIzMTJjNjA3ZDA5Mzk3NTFl Methods: (1987) evaluated the varus stress test and found rather poor diagnostic accuracy. Campbell SE, Sanders TG, Morrison WB. Place the affected leg in extension and slight external rotation. Consider reproduction of pain during the test as a positive test, not just the reproduction of a. Varus Stress Test of the Knee: Genu Varum (aka bow-leggedness, bandiness, bandy-leg, and tibia vara), is a physical deformity marked by (outward) bowing of the lower leg in relation to the thigh, giving the appearance of an archer's bow. Orthopaedics - A guide for practitioners. The sensitivity and specificity of the McMurray's test reported in the studies identified in this review vary widely (Table (Table5).5). 8600 Rockville Pike In addition, cited references of relevant articles were examined. The four possible outcomes include true positive, a false positive, a false negative, and a true negative (see Table Table2).2). 2nd ed. Given the results of the multivariate regression in Question 1, write the regression equation associated with this study. Sackett D, Richardson S, Rosenberg W, Haynes RB. 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. However, in general, the CI limits are relatively narrow over all. However, these authors stated that they determined these findings in a study of 20 subjects prior to the main study and they did not provide any details of how this pilot study was performed or analyzed. 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. Relatively narrow confidence intervals also attest to the reliability of these two studies3,4 (Table (Table55). 24 General examination included carrying angle (normal, valgus,. 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.
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