scholarly journals Comparison of Thessaly Test with Joint Line Tenderness and McMurray Test in the Diagnosis of Meniscal Tears

2020 ◽  
Vol 14 (2) ◽  
pp. 94-100
Author(s):  
Shekarchi B ◽  
Panahi A ◽  
Raeissadat SA ◽  
Maleki N ◽  
Nayebabbas S ◽  
...  
Keyword(s):  
Joint Line ◽  
Meniscal Tears ◽  
Joint Line Tenderness

Gender differences in the accuracy of joint line tenderness for arthroscopically confirmed meniscal tears

2015 ◽  
Vol 135 (11) ◽  
pp. 1567-1570 ◽  
Author(s):  
Barak Haviv ◽  
Shlomo Bronak ◽  
Yona Kosashvili ◽  
Rafael Thein
Keyword(s):  
Gender Differences ◽  
Joint Line ◽  
Meniscal Tears ◽  
Joint Line Tenderness

scholarly journals Diagnostic accuracy of the Thessaly test, standardised clinical history and other clinical examination tests (Apley’s, McMurray’s and joint line tenderness) for meniscal tears in comparison with magnetic resonance imaging diagnosis

2015 ◽  
Vol 19 (62) ◽  
pp. 1-62 ◽  
Author(s):  
Mark Blyth ◽  
Iain Anthony ◽  
Bernard Francq ◽  
Katriona Brooksbank ◽  
Paul Downie ◽  
...  
Keyword(s):  
Primary Care ◽  
Diagnostic Accuracy ◽  
Clinical History ◽  
Joint Line ◽  
Meniscal Tears ◽  
Physical Tests ◽  
Mri Diagnosis ◽  
Primary Care Clinicians ◽  
Joint Line Tenderness ◽  
Knee Pathology

BackgroundReliable non-invasive diagnosis of meniscal tears is difficult. Magnetic resonance imaging (MRI) is often used but is expensive and incidental findings are problematic. There are a number of physical examination tests for the diagnosis of meniscal tears that are simple, cheap and non-invasive.ObjectivesTo determine the diagnostic accuracy of the Thessaly test and to determine if the Thessaly test (alone or in combination with other physical tests) can obviate the need for further investigation by MRI or arthroscopy for patients with a suspected meniscal tear.DesignSingle-centre prospective diagnostic accuracy study.SettingAlthough the study was performed in a secondary care setting, it was designed to replicate the results that would have been achieved in a primary care setting.ParticipantsTwo cohorts of patients were recruited: patients with knee pathology (n = 292) and a control cohort with no knee pathology (n = 75).Main outcome measuresSensitivity, specificity and diagnostic accuracy of the Thessaly test in determining the presence of meniscal tears.MethodsParticipants were assessed by both a primary care clinician and a musculoskeletal clinician. Both clinicians performed the Thessaly test, McMurray’s test, Apley’s test, joint line tenderness test and took a standardised clinical history from the patient.ResultsThe Thessaly test had a sensitivity of 0.66, a specificity of 0.39 and a diagnostic accuracy of 54% when utilised by primary care clinicians. This compared with a sensitivity of 0.62, a specificity of 0.55 and diagnostic accuracy of 59% when used by musculoskeletal clinicians. The diagnostics accuracy of the other tests when used by primary care clinicians was 54% for McMurray’s test, 53% for Apley’s test, 54% for the joint line tenderness test and 55% for clinical history. For primary care clinicians, age and past history of osteoarthritis were both significant predictors of MRI diagnosis of meniscal tears. For musculoskeletal clinicians age and a positive diagnosis of meniscal tears on clinical history taking were significant predictors of MRI diagnosis. No physical tests were significant predictors of MRI diagnosis in our multivariate models. The specificity of MRI diagnosis was tested in subgroup of patients who went on to have a knee arthroscopy and was found to be low [0.53 (95% confidence interval 0.28 to 0.77)], although the sensitivity was 1.0.ConclusionsThe Thessaly test was no better at diagnosing meniscal tears than other established physical tests. The sensitivity, specificity and diagnostic accuracy of all physical tests was too low to be of routine clinical value as an alternative to MRI. Caution needs to be exercised in the indiscriminate use of MRI scanning in the identification of meniscal tears in the diagnosis of the painful knee, due to the low specificity seen in the presence of concomitant knee pathology. Further research is required to determine the true diagnostic accuracy and cost-effectiveness of MRI for the detection of meniscal tears.Trial registrationCurrent Controlled Trial ISRCTN43527822.FundingThe National Institute for Health Research Health Technology Assessment programme.

Accuracy of clinical diagnosis in meniscal tears

2020 ◽  
Vol 7 (2) ◽  
pp. 39-44
Author(s):  
Abhishek Kumar Thakur
Keyword(s):  
Diagnostic Accuracy ◽  
Clinical Evaluation ◽  
Compression Test ◽  
Lateral Meniscus ◽  
Joint Line ◽  
Meniscus Tear ◽  
Meniscal Tears ◽  
Clinical Tests ◽  
Set Up ◽  
Joint Line Tenderness

Introduction: Meniscal injuries of the knee are common indications for arthroscopic knee surgery. Most of the meniscal tears can be diagnosed by clinical evaluation alone. This study aims to test the accuracy of the commonly performed tests for meniscal tears in our set up. Method: This was a prospective observational study of 32 symptomatic knees that underwent clinical evaluation followed by arthroscopy. The sensitivity, specificity and diagnostic accuracy of three clinical tests (McMurray’s test, Apley’s compression test and Joint line tenderness) were calculated against arthroscopic findings. Result: Among clinical tests, maximum sensitivity (94.44%) was with Joint Line Tenderness for Medial Meniscus Tear (MMT) and minimum (54.54%) with Apley’s Compression Test for Lateral meniscus Tear (LMT). Specificity was maximum (90.48%) with Joint Line Tenderness for LMT and minimum (64.28%) with Apley’s Compression Test for MMT. Diagnostic accuracy was maximum (90.6%) with McMurray’s test for LMT and minimum (75%) with Apley’s Compression Test for MMT and LMT. Conclusion: All three clinical tests (McMurray’s, Apley’s compression and Joint line tenderness) were found reliable for diagnosing meniscus tears. Joint Line Tenderness had the best diagnostic accuracy followed by McMurray’s test.

scholarly journals Do Clinical Correlates of Knee Osteoarthritis Predict Outcome of Intraarticular Steroid Injections?

2019 ◽  
Vol 47 (3) ◽  
pp. 431-440 ◽  
Author(s):  
Nasimah Maricar ◽  
Matthew J. Parkes ◽  
Michael J. Callaghan ◽  
David T. Felson ◽  
Terence W. O’Neill
Keyword(s):  
Chronic Widespread Pain ◽  
Joint Line ◽  
Widespread Pain ◽  
Short Term ◽  
Steroid Injections ◽  
Clinical Correlates ◽  
Knee Oa ◽  
Symptomatic Knee ◽  
Unit Increase ◽  
Joint Line Tenderness

Objective.To determine whether clinical correlates of knee osteoarthritis (OA) affect the outcome of intraarticular steroid injections (IASI) in symptomatic knee OA.Methods.Men and women aged ≥ 40 years with painful knee OA who participated in an open-label trial of IASI completed questionnaires and clinical examination. The Outcome Measures in Rheumatology (OMERACT)–Osteoarthritis Research Society International (OARSI) criteria were used to assess response to therapy in the short term (within 2 weeks). Among those who initially responded, those whose pain had not returned to within 20% of the baseline Knee Injury and Osteoarthritis Outcome Score pain score at 6 months were characterized as longer-term responders. Log-binomial regression was used to examine factors associated with outcome.Results.One hundred ninety-nine participants were included, of whom 146 (73.4%) were short-term and 40 (20.1%) longer-term responders. Compared to short-term nonresponders, participants with these characteristics were more likely to be short-term responders: medial joint line tenderness [relative risk (RR) 1.42, 95% CI 1.10–1.82], medial and lateral joint line tenderness (RR 1.38, 95% CI 1.03–1.84), patellofemoral tenderness (RR 1.27, 95% CI 1.04–1.55), anserine tenderness (RR 1.27, 95% CI 1.06–1.52), and a belief that treatment would be effective [RR/unit increase (range 0–10) = 1.05 (1.01–1.09)]. Aspiration of joint fluid (RR 0.79, 95% CI 0.66–0.95) and previous ligament/meniscus injury (RR 0.63, 95% CI 0.44–0.91) were associated with a reduced risk of being a short-term responder. Compared to initial nonresponders and those whose pain recurred within 6 months, participants with a higher number of pain sites [RR/unit increase (range 0–10) = 0.83, 95% CI 0.72–0.97], chronic widespread pain (RR 0.32, 95% CI 0.10–0.98), perceived chronicity of disease [RR/unit increase (range 0–10) = 0.86, 95% CI 0.78–0.94], and a higher depression score [RR/unit increase (range 0–21) = 0.89, 95% CI 0.81–0.99] were less likely to be longer-term responders.Conclusion.Among patients with symptomatic knee OA, tenderness around the knee was associated with better short-term outcome of IASI. However, clinical-related factors did not predict longer-term response, while those with chronic widespread pain and depressive symptoms were less likely to obtain longer-term benefits.

Significance of Clinical Evaluation of the Metacarpophalangeal Joint in Relation to Synovial/Bone Pathology in Rheumatoid and Psoriatic Arthritis Detected by Magnetic Resonance Imaging

2009 ◽  
Vol 36 (12) ◽  
pp. 2751-2757 ◽  
Author(s):  
MILLICENT A. STONE ◽  
LAWRENCE M. WHITE ◽  
DAFNA D. GLADMAN ◽  
ROBERT D. INMAN ◽  
SAM CHAYA ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Psoriatic Arthritis ◽  
Magnetic Resonance ◽  
Disease Activity ◽  
Joint Line ◽  
Tender Joint Count ◽  
Kappa Statistics ◽  
Resonance Imaging ◽  
Tender Joint ◽  
Joint Line Tenderness

Objective.Rheumatologists base many clinical decisions regarding the management of inflammatory joint diseases on joint counts performed at clinic. We investigated the reliability and accuracy of physically examining the metacarpophalangeal (MCP) joints to detect inflammatory synovitis using magnetic resonance imaging (MRI) as the gold standard.Methods.MCP joints 2 to 5 in both hands of 5 patients with rheumatoid arthritis (RA) and 5 with psoriatic arthritis (PsA) were assessed by 5 independent examiners for joint-line swelling (visually and by palpation); joint-line tenderness by palpation (tender joint count, TJC) and stress pain; and by MRI (1.5 Tesla superconducting magnet). Interrater reliability was assessed using kappa statistics, and agreement between examination and corresponding MRI assessment was assessed by Fisher’s exact tests (p < 0.05 considered statistically significant).Results.Interrater agreement was highest for visual assessment of swelling (κ = 0.55–0.63), slight-fair for assessment of swelling by palpation (κ = 0.19–0.41), and moderate (κ = 0.41–0.58) for assessment of joint tenderness. In patients with RA, TJC, stress pain, and visual swelling assessment were strongly associated with MRI evaluation of synovitis. Visual swelling assessment demonstrated high specificity (> 0.8) and positive predictive value (= 0.8). For PsA, significant associations exist between TJC and MRI synovitis scores (p < 0.01) and stress pain and MRI edema scores (p < 0.04). Assessment of swelling by palpation was not significantly associated with synovitis or edema as determined by MRI in RA or PsA (p = 0.54–1.0).Conclusion.In inflammatory arthritis, disease activity in MCP joints can be reliably assessed at the bedside by examining for joint-line tenderness (TJC) and visual inspection for swelling. Clinical assessment may have to be complemented by other methods for evaluating disease activity in the joint, such as MRI, particularly in patients with PsA.

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