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Physical examination of the knee: a review of the original test description and scientific validity of common orthopedic tests

Gerard A Malanga, Steven Andrus, Scott F Nadler, James McLean
Archives of Physical Medicine and Rehabilitation 2003, 84 (4): 592-603
12690600

OBJECTIVES: To present the original descriptions of common orthopedic physical examination maneuvers of the knee and then to review the literature to support the scientific validity of these tests.

DATA SOURCES: MEDLINE (1970-2000) searches were performed, as were reviews of various musculoskeletal examination textbooks that describe physical examination maneuvers of the knee. These references were then reviewed for additional references and crossed back to the original description (when possible) of these named tests.

STUDY SELECTION: All articles that discussed the sensitivity and specificity of the physical examination maneuvers were extracted. This information was reviewed for accuracy and then summarized.

DATA EXTRACTION: Multiple MEDLINE and text searches were performed by using the terms of the test maneuver, the joint tested, and the term physical examination. Any article with this information was reviewed until the article describing the original description was found. Articles dating from that original article to the present were reviewed for information on the sensitivity and specificity of the test.

DATA SYNTHESIS: Literature reviewing the sensitivity and specificity of the tests reviewed is summarized in text and table form. The Lachman test seems to be very sensitive and specific for the detection of anterior cruciate ligament tears. For posterior cruciate ligament tears, the posterior drawer test is also very sensitive and specific and is enhanced with other tests, such as the posterior sag sign. For meniscal tears, the McMurray test is very specific but has a very low sensitivity, whereas joint line tenderness has fairly good sensitivity but lacks good specificity. Although collateral ligament testing seems to be sensitive and specific, there is a lack of well-designed studies that scientifically validate the sensitivity and specificity of these tests. Common tests for patellofemoral pain and patellar instability lack sensitivity when correlated with pathologic operative findings.

CONCLUSIONS: Most physical examination tests could be referenced back to an original description, with variable information on the sensitivity and specificity along with other information about the validity of these tests in clinical practice. To standardize how physical examinations are performed and compared, they should follow the original description or agreed-on standards. In addition, the significance of a physical examination finding must be understood to ensure that patients with knee complaints are accurately diagnosed and properly treated.

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