Research Methods
Karachalios, Hantes, Zibis, et al (2005). Diagnostic Accuracy of a New Clinical Test (the Thessaly Test) for Early Detection of Meniscal Tears. J Bone Joint Surg Am, 87, 955-962.
Part 1A- Critique -Quantitative
Research Question
What is the diagnostic accuracy of a new dynamic clinical test for the detection of meniscal tears?
a) This might be of relevance because the current diagnostic gold standard (MRI) is expensive and not always available.
b) Are current testing methods inaccurate? Are clinical tests inadequate compared to MRI?
Introduction seemed contradictory; as seventy five per cent accuracy of diagnosis can be made on history alone (Daniel, 1982; DeHaven, 1975) followed by specific clinical tests with above average accuracy. Very brief essentially, non-existent literature review. Besides mention of the population susceptible to meniscal injury, other relevant information pertaining to the injury wasn’t briefed. Such as, the mechanism of injury as well as the classic signs and symptoms experienced by an individual after meniscal pathology. Neither the introduction nor the brief literature review goes over what exactly sensitivity and specificity imply in the results. Sensitivity being how good the test is at detecting meniscal tears and specificity being how good the test is at identifying normal knee (Mohan, 2007). Also, there is no mention of what constitutes a false-positive and a false-negative result encountered during
Assessments are major depressive disorder, right knee medial meniscal tear post arthroscopy with recurrent tear and repeat arthroscopy, headache (concussion, cervical strain), lumbar strain and cervical degenerative disc disease.
Figure (14): Anteromedial view of the left knee, showing the injury grading scale established by the American Medical Association Standard Nomenclature of Athletic Injuries. Isolated grade-I injuries present with localized tenderness and no laxity. Isolated grade-II injuries present with a broader area of tenderness and partially torn medial collateral and posterior oblique fibers. Isolated grade-III injuries present with complete disruption, and there is laxity with an applied valgus stress. ( 70 )
The medical evidence shows the claimant had twisting injury to left knee with lateral meniscus tear on 7/1/13. He was also noted to have preexisting osteoarthritis of the left knee. The claimant underwent arthrosopic partial meniscectomy on the left knee on 2/27/14 with some symptomatic relief. An orthopedic report on 1/13/14 noted ongoing left knee pain. The physical exam showed tenderness; pain with flexion and extension; positive McMuray's test and negative Drawer's test. X-rays of left knee on 1/13/15 showed mild left knee osteoarthritis.
It has been shown, patients that have experienced an ACL tear will have clear radiographic signs of osteoarthritis.1 These signs appear in 10-20 years after the incident whether they had reconstruction surgery or opted out of surgery.1 In the article, Meniscus treatment and age associated with narrower radiographic joint space width 2-3 years after ACL reconstruction: data from the MOON onsite cohort, the authors goal was to find out whether radiographs of the metatarsophalangeal view would notice differences in the width of the joint space between an ACL reconstructed knee and the contralateral control knee within 2-3 years.1 Secondly, they wanted to indicate risk factors for early signs of post-traumatic osteoarthritis through an analysis
Women are at higher risk for many possible reasons, but none of which are 100 percent matter of fact. One of the reasons that Dr. Alpert suggests is that it could be hormonal. “Estrogen levels rise during certain hormonal cycles, which loosens the ligament and causes it to weaken, and
Upon further evaluation, the athlete may state that they have sharp, stabbing pain that occurs with turning, twisting, and squatting. When one presents these symptoms to a physician, the physician will then perform the impingement test. If this test recreates their hip pain, it indicates that it is positive and the physician may require imaging tests to help determine if they have FAI. The most common imaging tests performed are x-rays, CT scans, and MRI scans. X-rays are primarily to see if any arthritis is present within the joint, whereas CT and MRI scans can see the shapes and structures within the
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel's guide to physical examination (8th ed.). St. Louis, MO: Elsevier
This study hypothesizes that knee joint auscultation during Lachman test is capable of judging Anterior Cruciate Ligament on the basis of objective data. Particularly, frequency of Lachman sound is able to access ACL condition.MethodologyThis study was conducted in accordance to the protocol proved by the Institutional Review Board, which entailed two separate phases. First phase involved 30males and 30 females,healthy volunteers while the second phase involved 24 patients who went through ACL reconstruction.The Lachman test was performed by one orthopaedic surgeon
The test has the physician move the patellar back and forth while the patient flexes the knee at 30 degrees (Saladin, 1998, p. 44). This test helps diagnose how severe the patella is dislocated and decide the best treatment option. Another test a physician can do is called the patella tracking assessment where they have the patient single leg squat and then stand (Slamaian). If the “patella that slips medially on early flexion is called the J sign, and indicates imbalance between the VMO and lateral structures” (Saladin, 1998, p. 41). Both of these test help diagnose the correct treatment, the difference is the patellar apprehension test is used for more severe cases but both lead to the best treatment
In order to properly diagnose this type of injury, Dr. Erik Nilssen and his medical staff take several things into consideration, including the patient’s:
The Lachman Test is an important diagnostic test for detection of Anterior Cruciate Ligament (ACL) pathology (van Eck, 2013) and is frequently used by sports therapists. Joint arthrometry, magnetic resonance imaging (MRI), and diagnostic arthroscopy are all well-established methods to evaluate the knee for the presence of an ACL tear. However, the clinical gold standard, with well-established levels of accuracy for detecting this injury, is the Lachman test, which is performed with the patient in a supine position and the knee at 20° to 30° of flexion (Benjaminse, 2006; Ostrowski, 2006). The grading of the Lachman test is based on the amount of anterior translatory movement (translation) of the tibia relative to the femur and on the end-feel perceived by the examiner. A positive test requires a soft end-feel and observable translation of the tibia (Torg, 1976).
Brief Description of patient: - Patient is a 27 year old male that presents with atraumatic knee pain in his left knee. Patient has difficulty performing squats, lunges, and other knee related activities while exercising, he also has limited range of motion both active and passive. When tested for ligamentous issues all tests results were negative.
The Shoulder Pain and Disability Index (SPADI) score developed by Roach et al in 1991. ‘The SPADI contains 13 items that assess two domains; a 5-item subscale that measures pain and an 8-item subscale that measures disability.’ (Breckenridge & McAuley, 2011). Each item is measured on a scale of 1-10 (1 being lowest and 10 being highest). A total of the scores are summed and converted to a score out of 100 with a higher number indicating
Diagnostic tests : There is no specific single diagnostic test , there is combination of the display of the joint involved ; depend of clinical presentation : clinical, laboratory, and imaging features.
To diagnose osteoarthritis, the doctor will collect information on personal and family medical history, perform a physical examination and order diagnostic tests. Further tests such as X-rays or blood tests are not usually necessary to confirm a diagnosis of osteoarthritis, although they may be used to rule out other possible causes of the symptoms, such as rheumatoid arthritis or a fractured bone. X-rays can also allow doctors to assess the level of damage to the joints but this is rarely helpful as the extent of damage visible on an X-ray isn’t a good indicator of how severe the symptoms really are.