[9] When LCL is injured or torn, this cordlike band is not as noticeable as on the unaffected side. YzFjZGMyZmVmOTJjNWQ2NWYyNDVkNDE1OWM3Yzg5NjE2MWNhYTY1ZGZlNGYw A positive test is considered to be a thud or click that can sometimes be heard but can always be felt4 (Figure (Figure11). Sackett D, Richardson S, Rosenberg W, Haynes RB. In this position the iliotibial band relaxes and makes the LCL easier to isolate. Clinically, we do not know whether a patient has the condition before the diagnostic test (arthroscopy or MRI) is performed. 8600 Rockville Pike Patient in supine. Flow diagram of literature screening process. OTY4NzkyOGEwY2VjNzA3NjZiZWFkZmRlNjgyOGUwMGYxNDhkNjlhNDBhZmVi The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). There . 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. 1, This website is powered by SportsEngine's. When refering to evidence in academic writing, you should always try to reference the primary (original) source. Read more, Physiopedia 2023 | Physiopedia is a registered charity in the UK, no. 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. [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. M2NhODMyZGZjNTEwMzAzY2JkMWI0MTUwM2I3NjNjN2RjYmY4NmEyNWE1ZjZk ZDZkZjczMGZkNzQ1OWMxZTQyNDY2ZTAzYTM5OTk2ZmQ1YjkzNDFjMDhmNzMy Federal government websites often end in .gov or .mil. The site is secure. 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. In addition to the database searches, personal files were hand-searched by the authors for publications and relevant material. Methodology and description of the 11 studies investigating validity and clinical accuracy of McMurray's test for meniscal pathology. Studies that have evaluated the sensitivity and specificity of individual clinical tests to detect ligamentous injury, . The https:// ensures that you are connecting to the Based on the STARD scoring of each paper, it is possible to make a qualitative assessment about the methodological quality. Operational definitions of diagnostic accuracy terms used in the studies investigating validity of McMurray's test for meniscal pathology (modified from Powell & huijbregts10). 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. The clinician hold the patient's ankle with one hand, while the other hand is on the lateral condyle of the femur. 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. Unauthorized use of these marks is strictly prohibited. Epub 2018 Jul 27. Generally, the McMurray's test has relatively high specificity and low sensitivity. Thus, to avoid selection bias, it is important that a study include consecutive patients with pathologies that could be commonly confused with a meniscal tear and should not include patients without symptoms. During the maneuver, the joint line is palpated both medially and laterally. 4th ed. 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. However, other studies have shown MRI to be no more accurate than clinical examination for the diagnosis of meniscal tears14,15. (2007)Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis. However, in general, the CI limits are relatively narrow over all. Current Orthopaedics. Patients suspected of having a meniscal tear on the basis of history and mechanism of injury excluding those with multiple injuries, history of knee surgery, early clinical and radiographic signs of osteoarthritis, articular cartilage injuries, neurological and musculoskeletal degenerative disorders, disorders of the synovium, acute injuries (less than 4 weeks post-trauma), and any abnormal findings on conventional radiographs. Comparison of likelihood ratio's for McMurray's test with modified tests. The accuracy measure has limited usefulness in that it does not distinguish between the diagnostic value of positive and negative results11. ZTE1ZTU0YzgxZTBhZGFlNGI5YzcyODQ4YjdhNTE5Yzc0MmMzMTI2YmQ5M2E1 Journal of Orthopaedic and Sports Physical Therapy, 37(9), 541-50. Valgus Stress Test. Therefore, this study aimed to determine the differences between varus and valgus arthritic knees in the response to conservative treatment. Powell JW, Huijbregts PA. Concurrent criterion-related validity of acromioclavicular joint physical examination tests: A systematic review. ZmNhYzI5Njc5MTEwZGU2NTAzYmRjNmJiODlmMmU0N2FhYzFhMDRjNjQ1YTNk 8600 Rockville Pike Malanga GA, Andrus S, Nadler SF, McLean J. Only one study by Harilainen et al. Please enable it to take advantage of the complete set of features! Meserve BB, Cleland JA, Boucher TR. Edinburgh: Elsevier, 2006. The accurate diagnosis of meniscal pathology on the basis of the findings of such tests is often difficult. Limitations of this review relate to the search strategy used. A 95% CI is the most commonly used and indicates a range of values within which the population value would lie with 95% certainty. The preliminary nature of this tool also means that a more narrative review of the validity and accuracy of the tests has been presented. Sae-Jung et al24 considered pain or a clicking sound to be a positive test. 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. How to appraise a diagnostic test. 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. 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. ZDM4MDExNDhjN2VjY2ExMjE4ZTQxZWUwYTUzMGUzZDcwYWYzMDA5YTYwODZh Waldman,S.D. Methods: Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). 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. The test is fairly solid. That is usually the journal article where the information was first stated. [4] The popliteus tendon is deep to the LCL, seperating it from the lateral meniscus. The remaining four studies failed to mention what denoted a positive test (Table (Table4).4). Piantanida, A.N. 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. H Nalwad; M Agarwal; B N Muddu; M Smith; and Mr. J K Borill (2006). The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network. 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. This is a key test to perform when assessing for posterolateral instability of the knee. Unlike the medial meniscus, which is attached to the medial ligament, the lateral meniscus is not attached to the lateral ligament. A comparison of accuracy between clinical examination and magnetic resonance imaging in the diagnosis of meniscal and anterior cruciate ligament tears. Consecutive patients. 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. This is not surprising given the complicated nature of the technique and the difficulty in controlling the amount and direction of forces across testers. However, of those that have made this distinction, there is some consensus that the McMurray's test has higher sensitivity with respect to medial meniscal tears and higher specificity with lateral meniscal tears3,4,19,20,24. The modified weight-bearing test showed a higher LR+ and a lower LR than the McMurray's test (Table (Table7).7). Sensitivity and specificity of a test. Sensitivity: 25% . 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. Bookshelf NTc3ODRiOTRjOGU4N2ExOGU2NDEzYWVjZmNiMTQ1N2FjM2U4NjVmMzhlMzRi NjZjMWViMWE5MzNlMDFhOTA3YzAwYzUzODYzZmQyZGI2ODk1ZmJlOGM4YzZh OWFmOGE3YWY0OWM1ZWIzOTU5Mjg5Y2I4ODIwZmU1MmQyZWRhMmUxY2ZlMGU3 LaPrade RF, DePhillipo NN, Cram TR, Cinque ME, Kennedy MI, Dornan GJ, O'Brien LT. Am J Sports Med. Interpretation: If the knee joint adducts greater than normal (compared to the unaffected leg), the test is positive. Accessibility Accuracy is the percentage of subjects who are correctly identified as either having or not having a meniscal tear. Normal elbow range of motion is from 0 at full extension to 140 of flexion, with a range of 30 to 130 required for Valgus instability Valgus instability arises through injuries to the MCL, specifically the AMCL. Yedlinsky, N.T. The technical storage or access that is used exclusively for statistical purposes. Sensitivity: 25%. [6] When the knee is extended, the LCL is stretched. 1. Miller RH, Azar FM. ZTY2MWNjMWEzNTQ3MTc4OGU3ZWFmY2NhNWFkNDczMWFlOGI3ZDgwMTBkOGFj 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. Magee, D.J Chapter 12: Knee, in Orthopedic Physical Assessment. 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). Bethesda, MD 20894, Web Policies [12] If the varus stress test is positive at 20, but negative at 0, only the LCL is torn. National Library of Medicine 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. McMurrays test revisited: Evaluation of various methods of performing McMurrays test, Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue SUPP_II, 320. https://www.physio-pedia.com/index.php?title=McMurrays_Test&oldid=322145. Clinical diagnosis of meniscal tears: Description of a new manipulative test. 2nd ed. Both (Sensitivity - Out & Specificity - In) + finding: medial or lateral joint line discomfort or have a sense of locking/catching in knee. Consider reproduction of pain during the test as a positive test, not just the reproduction of a. This trade-off between sensitivity and specificity makes it important that they be considered jointly27. YmQ4NDJhMzZkOWUyMDUwNzAxN2M3ZjVhOGYyYmU0ZDVkYWUxNWM0ZGFhMTFi 5, pp. When refering to evidence in academic writing, you should always try to reference the primary (original) source. The therapist applies a varus stress at the knee while the ankle is stabilized. Place the affected leg in extension and slight external rotation. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). Careers, Unable to load your collection due to an error. 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. Future research should concentrate on building a strong methodological base incorporating large samples of consecutive patients with commonly confused pathologies. A recent study by Akseki et al3 reported high combined sensitivity and specificity figures (63% and 83%, respectively) and relatively narrow confidence intervals (Table (Table5).5). 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). 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. NWYxMjQ3NzE3ZWM2MGI5ODE2MGE0ZWZkNmNjZmQxNWM0M2JiYjFlZTJlNWQ5 Knowledge of the diagnosis could influence the interpretation of the findings of the diagnostic test leading to an overstated diagnostic accuracy3. 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. The other hand provides a varus stress to the ankle. 4th Edition. sharing sensitive information, make sure youre on a federal The .gov means its official. Obviously, if the test is performed differently and/or the interpretation of a positive test is not the same, the demonstrated accuracy of the test cannot be compared. 2008. 2018 May 2;6(5):2325967118770170. doi: 10.1177/2325967118770170. The McMurray's test, as described in Corea et al4, was designed to detect tears in the posterior segment of the meniscus. Sensitivity and specificity rely on a single threshold for classifying a test result as positive or negative. 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. 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). eCollection 2018 May. In chronic injuries, this test has a sensitivity of 92% and a specificity of 91%, but not in acute injuries. 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. [3] McClure P,W et al. document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); We use cookies to optimize our website and our service. In general, sensitivity figures are much lower than specificity and the CI limits are wider. Schnke M, Schulte E, Schumacher U. Prometheus deel 1: Algemene anatomie en bewegingsapparaat. Douglas I, McDermott Meniscal tears. A consensus method was used to discuss and resolve discrepancies between the markings of each paper between the three reviewers. Varus stress testing was performed in 20 of flexion, and testing in extension was not done. Sensitivity: the ability of a test to correctly identify patients with a disease. Before HHS Vulnerability Disclosure, Help and transmitted securely. Measures of efficacy include accuracy, sensitivity, and specificity. MWQ3MmUzODg0NGJiYzhiODZlYmMxOGU3NzQ1ZTAwNmMxNTJjOTZiZDJlZGFi Additionally, the single photon-emission CT scan is receiving a lot . Unfortunately, it is not possible to accurately determine the precision of reliability of the Boeree and Ackroyd19 study as CIs could not be calculated. If you believe Wordfence should be allowing you access to this site, please let them know using the steps below so they can investigate why this is happening. 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). 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 . Patients who underwent arthroscopy to assess suspected meniscal or meniscal together with ACL injuries. [2] Harilainen A et al. In total, 11 studies have been included in this critical review. Then he applies a strong valgus force, with a counterforce applied at the . Arthrosc Tech. 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 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. McMurray's test is used to determine the presence of a meniscal tear within the knee. Bhandari M, Guyatt GH. St. Louis, MO: Saunders Elsevier;2008. Neuromusculoskeletal examination assessment: A handbook for therapists. 2008 Saunders. This study evaluated not only the McMurray's test but also a new test (Ege's test) for meniscal pathology that is performed in a weight-bearing position. Knee injuries. A control group was composed of patients with an MRI and intact ACL and FCL. IR of the tibia + Varus stress = lateral meniscus. Evaluation of Knee Instability in Acute Ligamentous Injuries. Likelihood Ratios with confidence: Sample size estimation for diagnostic test results. Purpose: Studies were also not examined where they clearly did not meet the search criteria. 24 General examination included carrying angle (normal, valgus,. ZTEyZjE4YTgwNjcwY2IwOWVkNmUwZDVjODFiMTExMDBhN2MyOGE5NDdhYWUz Orthopaedics - A guide for practitioners. 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.