varus stress test sensitivity and specificity

Operational definitions of diagnostic accuracy terms used in the studies investigating validity of McMurray's test for meniscal pathology (modified from Powell & huijbregts10). 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. This was a purposeful strategy designed to enhance their ability to determine the true sensitivity and specificity of the McMurray's test in a population that reflects the symptomatic knee cohort that presents clinically. On the basis of the results of the studies in this review, it seems that intertester reliability using the McMurray's test is low. Churchill Livingstone, 2002. Whiting WC, Zernicke RF. official website and that any information you provide is encrypted These authors demonstrated significantly larger (better) positive likelihood ratios and significantly smaller (better) negative likelihood ratios than the McMurray's. They commented that the lack of intertester agreement may have been due to differences in the amount of force produced. Physical examination tests for assessing a torn meniscus in the knee: A systematic review with meta-analysis. 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% . Harilainen A. 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. Hoppenfeld S, Hutton R, Hugh T. Physical examination of the spine and extremities. Medicina | Free Full-Text | Valgus Arthritic Knee Responds Better to The acute tears frequently result from sports injuries where there is a twisting motion on the partially flexed, weight-bearing knee.[3]. Elbow Varus Instability Stress TestLateral Collateral Ligament Medline and CINAHL search strategy via OVID. 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. The four possible outcomes include true positive, a false positive, a false negative, and a true negative (see Table Table2).2). Campbell SE, Sanders TG, Morrison WB. PMC Prospective evaluation of the McMurray test. Apply slight lateral rotation and perform passive adduction at the knee joint and thus put stress on the LCL. The majority of studies did not report intertester or intratester reliability of the McMurray's test. However, for medial meniscal tears, rates are lower. 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. Akseki et al3 included consecutive patients with symptoms related to intra-articular knee pathology although how this was determined was not described. 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. Unauthorized use of these marks is strictly prohibited. Biomechanics and physical examination of the - ScienceDirect Although the support of a clinical study is needed in order to make a definite conclusion, the dial test is probably not reliable in the presence of medial instability, 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). The https:// ensures that you are connecting to the In chronic injuries, this test has a sensitivity of 92% and a specificity of 91%, but not in acute injuries. Valgus Stress Test Of The Knee 2023 | OrthoFixar When confidence intervals are not present, the CIs were incalculable due to absence of raw data. how likely a negative 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. 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. 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. Consecutive patients suspected of having meniscal tears presenting for arthroscopy: acute and chronic (ligament injuries excluded). As a library, NLM provides access to scientific literature. The accuracy measure has limited usefulness in that it does not distinguish between the diagnostic value of positive and negative results11. Then he applies a strong valgus force, with a counterforce applied at the . 13th ed. Consecutive patients. ZmY3MzI2ODBmYTBhMDEzNzY3YmRkZjU0MDRhM2U2ODliZTFmOWMzYWI0MWI5 . official website and that any information you provide is encrypted 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. The proportion of people who do not have the disease or dysfunction who test negative. MDYzNWEzNGQxNDFiMmU0MDBmMmJkZTU4YzNiNzE1MWYxNWM3ZGU1NzFkM2Zm The proportion of people who have the disease or dysfunction who test positive. Use of methodological standards in diagnostic test research: Getting better but still not good. The accuracy of joint line tenderness by physical examination in the diagnosis of meniscal tears Arthroscopy. Both (Sensitivity - Out & Specificity - In) + finding: medial or lateral joint line discomfort or have a sense of locking/catching in knee. 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. OGNkMmFkZGY0YjIxNzkxN2RkOTg3YzgzMTdiYjY1OGMxMzA2NThmZjIxNGNi M2YxNmU0NGVlMWUwYjVjMDY4MzIwZjY3OTJmYTc0YzFhMDIyMDAwNTVhNGJm In addition to the database searches, personal files were hand-searched by the authors for publications and relevant material. 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. [1]. Methods: 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. YzM5MWNkYzMyMjQ0ZmU4MDdjZjg2NzYxZjhlMGI2N2RmMGI3ODExOWFmMDdl The therapist applies a varus stress at the knee while the ankle is stabilized. Mariani et al30 have suggested that the differences in anatomical attachments of the two menisci contribute to these variations in sensitivity and specificity of diagnostic tests30. Purpose: The Varus Stress Test is used to assess the integrity of the LCL or lateral collateral ligament of the knee. The final two studies20,21 limited their study population to patients suspected of meniscal injury. In extension, the posterior capsule and cruciate ligaments act as secondary restraints for varus stress. (2008) A meta-analysis examining clinical test utilities for assessing meniscal injury. DOI https://doi.org/10.1016/C2009-1-59662-1. 2022 Jun 6;10(6):23259671221100216. doi: 10.1177/23259671221100216. (2007)Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis. 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). Saunders. The Valgus Test of the knee is performed with the patient lies in the supine position. Saunders Elsevier. 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. 8600 Rockville Pike Sensitivity and specificity values fail to do this11. The Valgus Stress Test for LCL injuries has hardly been evaluated regarding its diagnostic accuracy. LaPrade RF, DePhillipo NN, Cram TR, Cinque ME, Kennedy MI, Dornan GJ, O'Brien LT. Am J Sports Med. A recent meta-analysis illustrates the difference in test characteristics when performed on patients under anesthesia. 2018 Aug;46(10):2355-2365. doi: 10.1177/0363546518784301. Check for excessive gapping and if you can reproduce the patients pain. Does the patient have a torn meniscus of ligament of the knee? sharing sensitive information, make sure youre on a federal Physical Examination of the Knee | Musculoskeletal Key Results: Likelihood ratios overcome some of the problems involved with sensitivity and specificity values by summarizing the information contained in these values in a manner that can be used to quantify shifts in probability once the meniscal test results are known28. Bethesda, MD 20894, Web Policies Baker PE, Peckham AC, Pupparo F, Sanborn JC. 133k Limiting the search to English language articles only may also have led to an omission of other relevant studies. 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. Although blinding was not mentioned in respect to the other studies, the majority required the clinical examination to be performed prior to the diagnostic arthroscopy, suggesting that the examiner would indeed be blinded to the results of the diagnostic test. Kennedy MI, Akamefula R, DePhillipo NN, Logan CA, Peebles L, LaPrade RF. Elbow Valgus Stress Test 2023 | OrthoFixar

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