Special Tests In Musculoskeletal Examination: A...
A complete review of all these tests is beyond the scope of this article. This review emphasizes commonly cited tests for cervical, shoulder, pelvis and hip disorders, as these are areas of greatest clinical complexity where combinations of special tests may be more accurate.
Special Tests in Musculoskeletal Examination: A...
Accuracy, reproducibility, and validity of individual tests are controversial, although combinations of tests are likely to be more accurate. Individual tests probably detect pain from more than one pathoanatomical structure; therefore, multiple tests performed in the context of an overall examination are more useful than relying on a single test to diagnose a specific structural pathology. Comparison with contralateral side or limb may also be helpful. Three or more positive tests for SI pathology improves predictive power compared to intra-articular injection tests. Evaluation of combinations of specific musculoskeletal tests for improved diagnostic accuracy and validity is an emerging area of research.
A doctor can often diagnose a musculoskeletal disorder based on the history and the results of a physical examination Physical Examination The musculoskeletal system comprises bones, muscles, joints, ligaments, tendons, and bursae (see Introduction to Biology of the Musculoskeletal System). Any of these components can be injured... read more . Laboratory tests Laboratory Tests A doctor can often diagnose a musculoskeletal disorder based on the history and the results of a physical examination. Laboratory tests, imaging tests, or other diagnostic procedures are sometimes... read more , imaging tests Imaging Tests A doctor can often diagnose a musculoskeletal disorder based on the history and the results of a physical examination. Laboratory tests, imaging tests, or other diagnostic procedures are sometimes... read more , or other diagnostic procedures Other Diagnostic Procedures A doctor can often diagnose a musculoskeletal disorder based on the history and the results of a physical examination. Laboratory tests, imaging tests, or other diagnostic procedures are sometimes... read more are sometimes necessary to help the doctor make or confirm a diagnosis.
Laboratory tests are often helpful in making the diagnosis of a musculoskeletal disorder. For example, the erythrocyte sedimentation rate (ESR) is a test that measures the rate at which red blood cells settle to the bottom of a test tube containing blood. The ESR is usually increased when inflammation is present. However, because inflammation occurs in so many conditions, the ESR alone does not establish a diagnosis.
Arthrography is an x-ray procedure in which a radiopaque dye is injected into a joint space to outline the structures, such as ligaments inside the joint. Arthrography can be used to view torn ligaments and fragmented cartilage in the joint. However, magnetic resonance imaging Computed tomography (CT) and magnetic resonance imaging (MRI) A doctor can often diagnose a musculoskeletal disorder based on the history and the results of a physical examination. Laboratory tests, imaging tests, or other diagnostic procedures are sometimes... read more (MRI) is now generally used in preference to arthrography.
Objectives: To review the literature, identify and describe commonly used special tests for diagnosing injury to the ligaments of the ankle complex, present the distinguishing characteristics and limitations of each test, and discuss the current evidence for the clinical use of each test.
Data sources: Multiple PubMed (1920-2018) and CINAHL (1920-2018) searches were conducted and various musculoskeletal examination textbooks were reviewed to examine common orthopedic tests used to assess the ankle. The articles were reviewed for additional references and the search continued until the original description was found when possible.
Data synthesis: The literature was reviewed, commonly used special tests for diagnosing ankle injuries were identified and described, distinguishing characteristics and limitations of each test were presented, and the current evidence for the clinical use of each test was discussed.
Conclusions: A complete physical examination is critical in the diagnosis of ankle injuries. The combination of available information such as mechanism of injury, all signs and symptoms, and changes in gait, is key to a conclusive and correct diagnosis. Clinicians should be aware of the severely limited evidence supporting the use of many commonly used special tests. Applying evidence from the literature will improve diagnostic accuracy. Further research is needed to understand the performance ability of special tests, both individually and when grouped as part of a test battery.
There are three elements to the physical examination. They are colloquially termed "look, feel, move" by Apley; or more precisely termed inspection, palpation, and movement testing. The sequence "look, feel, move" is appropriate for fractures, but for most other musculoskeletal conditions the sequence "look, move, feel" is more suitable. A fourth category is special tests.
Despite growing reliance on imaging, clinical examination remains the bedrock of diagnosis of the musculoskeletal patient. Special tests have widespread utility particularly in sport and can often help to elucidate a patient's presentation where the lesion is subtle and otherwise difficult to detect and, in turn, guide management and treatment. Special Tests in Musculoskeletal Examination 2nd Edition is a pocketbook guide to over 100 peripheral tests.
There are many special tests clinicians can use to diagnose orthopedic and other musculoskeletal impairments. The orthopedic tests listed on this page are designed as a quick reference based on region and further classified into special test based on impairment if indicated.
During an evaluation, the clinician may use special tests to help guide the evaluation and assessment. While many of these tests are highly reliable, it it important to understand that special tests should be regarded as one component of the examination.
Some popular special tests may not have strong reliability or statistical power. This is noted in the Test Accuracy / Reliability section of each test. For a better understanding of these measures and terms, read the article: Reliability: Specificity and Sensitivity.
While special tests are not designed to take the place of a carefully performed musculoskeletal evaluation, they can provide important data points that help to support or refute a diagnosis. The data from these tests may also guide your treatment options and help you in explaining the dysfunction to the patient.
The performance of special tests with the intention of diagnosing or providing treatment recommendations for someone experiencing symptoms should be performed only by a licensed medical professional such as a PT, OT, medical doctor or athletic trainer.
While the actual timing of special test performance may vary from patient to patient, the big picture idea is to gather as much information as possible from the patient through subjective history taking, observation / palpation, and muscle / movement tests before provoking symptoms with special orthopedic tests.
The most important thing to remember with special tests is to no allow the test to become a crutch in your evaluation or assessment of the patient. These tests are simply tools to support your clinical reasoning and should not be a substitution for critical thinking and problem solving.
There is never a set number of special tests required for clinicians to perform during an evaluation. Whether a test is positive or negative, you may want to perform a secondary test to narrow down your ideas for the underlying pathology.
This study adhered to the state of the art methodology for systematic reviews and diagnostic meta-analysis. A broad scope without limitations to any specific shoulder diagnoses was chosen to strengthen the potential clinical applicability of results. In the meta-analysis, a clear description of inclusion criteria was made mandatory for primary studies to ensure that applicability in other clinical settings can be assessed for all studies included. The chosen QUADAS cutoff in this study was in line with that used in several previous reviews [14, 48] and particularly strong selection criteria were used for the meta-analysis to ensure inclusion of only high quality primary studies with a low risk of bias. However, with strong selection criteria, there is a risk that relevant primary studies were excluded from the meta-analysis and that this may have biased our conclusions. In addition the application of a QUADAS cutoff score has been advised against by its developers [49] and our choice may have induced a selection bias of primary studies. Also, due to the small number of primary studies available for pooling, hierarchical or bivariate random effects modeling were not feasible. However, since heterogeneity was low, a fixed effects approach could be used. A revised edition of the original QUADAS tool has been published [50]. Implementation was not possible in this review as QUADAS scoring had already started with the original tool. This was a meta-analysis of single PETS but in clinical practice a combination of tests is commonly used. Several of the included primary studies reported diagnostic performance when different tests were combined [3, 26, 34, 35, 37]. However, as test combinations differ, meaningful statistical pooling was not feasible and assessment of test combinations was beyond the specific scope of this meta-analysis. Another important limitation regarding conclusions and recommendations of this meta-analysis is the designated context of specialist care with high prevalence of shoulder pathology and co-morbidity. Care should be taken to assess applicability of results to any specific clinical context. To enable clinicians to assess transferability of primary research findings to their own specific spectrum of patients, we only included studies where inclusion criteria had been clearly described. The extraction of raw data from the included primary studies have been provided for clinicians own scrutiny (Additional file 5). 041b061a72