McMurray’s test is useful clinical test to assess injury to?
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Correct Answer:
Meniscus injury
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Ans. C. Meniscus injury. (Ref. Orthopedics by Ebnezar 4th/Pg. 257).A positive McMurray fs test is diagnostic of a meniscal injury.McMurray test# The McMurray test, also known as the McMurray circumduction test is used to evaluate individuals for tears in the meniscus of the knee. It is a rotation test for demonstrating tom cartilage of the knee. A tear in the meniscus may cause a pedunculated tag of the meniscus which may become jammed between the joint surfaces,# To perform the test, the knee is held by one hand, which is placed along the joint line, and flexed to complete flexion while the foot is held by the sole with the other hand. The examiner then places one hand on the lateral side of the knee to stabilize the joint and provide a valgus stress in order to identify a valgus deformity. The other hand rotates the leg externally while extending the knee. If pain or a "click" is felt, this constitutes a "positive McMurray test" for a tear in the medial meniscus. Likewise the medial knee can be stabilized in a fully flexed position and the leg internally rotated as the leg is extended. A tag, caused by a tear will cause a palpable or even audible click on extension of the knee. A positive test indicates a tear of the lateral meniscus.# Studies show that this clinical test had a sensitivity of 58.5%, a specificity of 93.4%, and the predictive value of a positive result was 82.6%.The pivot-shift test, anterior drawer test and the Lachman test are used during the clinical examination of suspected ACL injury.Anterior drawer testThe anterior drawer test for anterior cruciate ligament laxity is one of many medical tests used to determine the integrity of the anterior cruciate ligament. It can be used to help diagnose sprain and tears.The test is performed as follows: the patient is positioned lying supine with the hip flexed to 45deg and the knee to 90deg. The examiner positions themselves by sitting on the examination table in front of the involved knee and grasping the tibia just below the joint line of the knee. The thumbs are placed along the joint line on either side of the patellar tendon. The index fingers are used to palpate the hamstring tendons to ensure that they are relaxed; the hamstring muscle group must be relaxed to ensure a proper test. The tibia is then drawn forward anteriorly. An increased amount of anterior tibial translation compared with the opposite limb or lack of a firm end-point indicates either a sprain of the anteromedial bundle of the ACL or a complete tear of the ACL. This test should be performed along with other ACL-specific tests to help obtain a proper diagnosis.Lachman testThe Lachman test is an orthopedic test used for examining the anterior cruciate ligament (ACL) in the knee for patients where there is a suspicion of a tom ACL.The Lachman test is most reliable and sensitive clinical test for the determination of anterior cruciate ligament integrity.# The knee is flexed at 20-30 degrees# Examiner pulls on the tibia to assess the amount of anterior motion of the tibia in comparison to the femur# An ACL-deficient knee will demonstrate increased forward translation of the tibia at the conclusion of the movementPivot shift test# Test to asses ACL injuryPerson lies on one side of the body# Knee is extended and internally rotated# Surgeon applies stress to lateral side of the knee, while the knee is being flexed# A crash felt at 30 degrees flexion indicates positive test.Some clinical Orthopedic tests:DeQuervain's diseaseFinkelstein's testAnterior shoulder instabilityJobe's testSubscapularis injuryLift off testAcromioclavicular joint pathology and Labral tearsO'Brien's active compression testHip dysplasiaBarlow's maneuver, Ortolani testHip Impingement (Femoroacetabular Impingement)Flexion, Adduction and Internal Rotation (F-Ad-lr) testLow back painWaddell's signsLow back flexibilityOtt test, Schober testIliotibial Band SyndromeOber's testSacroiliitisLarrey's signBest clinical test to diagnose ACL tearLachman testACL tearPivot shift test, Anterior drawer testMeniscus injuryApley grind test, McMurray testMedial meniscus, MCL and ACL tearO' Donoghue's triadMeniscal tearThessaly TestTendo Achilles ruptureThompson/ Simond's testWatson's testInstability between the scaphoid and lunate bones of the wrist.Meniscal injury:# A twisting injury which is the common mechanism of injury in sports tackles involving the legs usually leads to a meniscal tear.# Injury to the medial meniscus is far more common than lateral meniscal injury. This is due to the medial meniscus being less mobile and thinner anteriorly.# Healing may be slow especially if the tear involves the deeper/inner 2/3 where there is a poor blood supply compared to the superficial/outer l/3rd.# Treatment:a) Conservative - Analgesia, supportive treatmentb) Surgical - Repair of meniscus, meniscectomy
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