Thessaly test: Difference between revisions

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'''Original Editor '''- [[User:Kristen Mason|Kristen Mason]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} &nbsp;  
'''Original Editor '''- [[User:Kristen Mason|Kristen Mason]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} &nbsp;  
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== Purpose<br>  ==


Clinical screening tool for meniscal tears.<ref name="Karachalios">Karachalios T, Hantes M, Zibis AH, Zachos V, Karantanas AH, Malizos KN. Diagnostic accuracy of a new clinical test (the Thessaly test) for early detection of meniscal tears. J Bone Joint Surg Am.  2005;87(5):955-962.</ref>
== Purpose ==


<br>
Clinical screening tool for meniscal tears/ lesions.


[[Image:Knee-joint-meniscus.jpg|knee joint menisci]]&nbsp;&nbsp;  
Patients with suspected meniscal tears experience medial or lateral joint-line discomfort and may have a sense of locking or catching. The Thessaly test is a dynamic reproduction of joint loading in the knee and the theory behind the test is that the knee with a meniscal tear will produce the same symptoms the patient reported. <ref name="Karachalios">Karachalios T, Hantes M, Zibis AH, Zachos V, Karantanas AH, Malizos KN. Diagnostic accuracy of a new clinical test (the Thessaly test) for early detection of meniscal tears.  J Bone Joint Surg Am.  2005;87(5):955-962.</ref><br>


== Technique<br> ==
[[File:Knee Joint.jpg|600x600px]]<ref>Illustration from Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013.</ref>
== Technique ==
The patient stands flat footed on one leg while the examiner supports the patient by holding their outstretched hands. The patient then flexes the knee to 5° and rotates the femur on the tibia medially and laterally three times, while maintaining the 5° flexion. The uninjured leg is tested first so that the patient may be trained with regard to how to keep the knee in the flexed position. The test is then repeated at 20° flexion. <ref name="Karachalios" /> The test is considered positive for a meniscus tear if the patient experiences medial or lateral joint line discomfort or a sense of locking/ catching in the knee. <br>  


The Thessaly test is a dynamic reproduction of joint loading in the knee.&nbsp; The test is performed at 5° and 20°<br>of flexion. The examiner supports the patient by holding his or her outstretched hands while the patient stands flatfooted on the floor. The patient then rotates his or her knee and body, internally and externally, three times, keeping the knee in slight fiexion (5°).&nbsp; The same procedure is then carried out with the knee flexed at 20°.
<clinicallyrelevant id="84562005" title="Thessaly test" />


Patients with suspected meniscal tears experience medial or lateral joint-line discomfort and may have a sense of locking or catching. The theory behind the test is that, with this maneuver, the knee with a meniscal tear is subjected to excessive loading cunditions and almost certainly will have the same symptoms that the patient reported. The test is always performed first on the normal knee so that the patient may be trained, especially wilh regard to how to keep the knee in 5° and then in 20° of flexion.<ref name="Karachalios" /><br> {{#ev:youtube|84pZh0n_rMg|300}}<ref>Clinically Relevant Technologies, http://www.youtube.com/watch?v=84pZh0n_rMg Accessed May 2011</ref>
== Evidence  ==


== Evidence<br> ==
In his original study from 2005,&nbsp;Karachalios <ref name="Karachalios" />&nbsp;found the following statistics for his test:&nbsp;<br>Thessaly Test at 5°<br>  


Thessaly Test at 5°<br>
{| width="400" border="1" cellpadding="1" cellspacing="1"
|-
|
| Sensitivity
| Specificity
| +LR
| -LR
|-
| Injury to Medial Meniscus
| 0.66
| 0.96
| 16.5
| 0.35
|-
| Injury to Lateral Meniscus
| 0.81
| 0.91
| 9
| 0.21
|-
| Combined Injury of ACL and Meniscus
| 0.65
| 0.83
| &nbsp; &nbsp;-
| &nbsp; -
|}


Injury to Medial Meniscus: Sensitivity = 0.66, Specificity = 96%, + LR = 16.5, -LR = 0.35<br>  
<br>  


Injury to Lateral Meniscus: Sensitivity = 0.81, Specificity = 0.91, +LR = 9, -LR = 0.21<br>
Thessaly Test at 20°&nbsp;


Combined Injury of ACL and Meniscus: Sensitivity = 0.65, Specificity = 0.83<br>
{| width="400" border="1" cellpadding="1" cellspacing="1"
|-
|
| Sensitivity
| Specificity
| +LR
| -LR
|-
| Injury to Medial Meniscus
| 0.89
| 0.97
| 29.67
| 0.11
|-
| Injury to Lateral Meniscus
| 0.92
| 0.96
| 23
| 0.21
|-
| Combined Injury of ACL and Meniscus  
| 0.80
| 0.91
|
|
|}


<br>  
<br>  


Thessaly Test at 20° <br>  
In more recent studies&nbsp;<ref>Goossens P, Keijsers E, Van Geenen RJ, Zijta A, Van den Broek M, Verhagen AP, Scholten-Peeters GG. Validity of the Thessaly test in evaluating meniscal tears compared with arthroscopy: a diagnostic accuracy study. journal of orthopaedic &amp; sports physical therapy. 2015 Jan;45(1):18-24.</ref><ref name=":0">Snoeker BA, Lindeboom R, Zwinderman AH, Vincken PW, Jansen JA, Lucas C. Detecting Meniscal Tears in Primary Care: Reproducibility and Accuracy of 2 Weight-Bearing Tests and 1 Non–Weight-Bearing Test. The Journal of orthopaedic and sports physical therapy. 2015 Sep 1;45(9):693-702.</ref><ref>Blyth M, Anthony I, Francq B, Brooksbank K, Downie P, Powell A, Jones B, MacLean A, McConnachie A, Norrie J. 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. Health Technology Assessment. 2015.</ref>&nbsp;from 2015, the Thessaly test has been&nbsp;found to be no better than other tests such as the&nbsp;[http://www.physio-pedia.com/McMurrays_Test McMurray test]&nbsp;and&nbsp;[http://www.physio-pedia.com/Apley's_Test Apley's Test]. When compared to McMurray, medial joint line tenderness and lateral joint line tenderness in a study from 2016, the Thessaly test was found reliable<ref>Decary, Simon, et al. "Reliability of physical examination tests for the diagnosis of knee disorders: evidence from a systematic review." ''Manual therapy'' 26 (2016): 172-182.</ref>.  
 
Injury to Medial Meniscus: Sensitivity = 0.89, Specificity = 0.97, +LR = 29.67, -LR = 0.11
 
Injury to Lateral Meniscus: Sensitivity = 0.92, Specificity = 0.96, +LR = 23, -LR = 0.21


Combined Injury of ACL and Meniscus: Sensitivity = 0.80, Specificity = 0.91 <ref name="Karachalios" />  
{| width="400" border="1" cellpadding="1" cellspacing="1"
|-
|
| Sensitivity
| Specificity
| +LR
| -LR<br>
|-
| Thessaly Test in recent studies
| 0.64- 0.66
| 0.39-0.53
| 1.37
| 0.67
|}


== Key Evidence  ==
<br>In a study by Snoeker et al. from 2015, the Thessaly test had a moderate level of inter-examiner reliability with a kappa of 0.54<ref name=":0" />


Karachalios T, Hantes M, Zibis AH, Zachos V, Karantanas AH, Malizos KN. Diagnostic accuracy of a new clinical test (the Thessaly test) for early detection of meniscal tears.&nbsp; ''J Bone Joint Surg Am. &nbsp;''2005;87(5):955-962.<br>
== Continue reading on Physiopedia: ==
* [[Knee]]
* [[Meniscal Lesions]]
* [[Meniscus rupture]]
* [[Meniscal Repair]]


BACKGROUND: Clinical tests used for the detection of meniscal tears in the knee do not present acceptable diagnostic sensitivity and specificity values. Diagnostic accuracy is improved by arthroscopic evaluation or magnetic resonance imaging studies. The objective of this study was to evaluate the diagnostic accuracy of a new dynamic clinical examination test for the detection of meniscal tears. METHODS: Two hundred and thirteen symptomatic patients with knee injuries who were examined clinically, had magnetic resonance imaging studies performed, and underwent arthroscopic surgery and 197 asymptomatic volunteers who were examined clinically and had magnetic resonance imaging studies done of their normal knees were included in this study. For clinical examination, the medial and lateral joint-line tenderness test, the McMurray test, the Apley compression and distraction test, the Thessaly test at 5 degrees of knee flexion, and the Thessaly test at 20 degrees of knee flexion were used. For all clinical tests, the sensitivity, specificity, false-positive, false-negative, and diagnostic accuracy rates were calculated and compared with the arthroscopic and magnetic resonance imaging data for the test subjects and the magnetic resonance imaging data for the control population. RESULTS: The Thessaly test at 20 degrees of knee flexion had a high diagnostic accuracy rate of 94% in the detection of tears of the medial meniscus and 96% in the detection of tears of the lateral meniscus, and it had a low rate of false-positive and false-negative recordings. Other traditional clinical examination tests, with the exception of joint-line tenderness, which presented a diagnostic accuracy rate of 89% in the detection of lateral meniscal tears, showed inferior rates. CONCLUSIONS: The Thessaly test at 20 degrees of knee flexion can be used effectively as a first-line clinical screening test for meniscal tears, reducing the need for and the cost of modern magnetic resonance imaging methods.<br>
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
<div class="researchbox"><rss>http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=14mzXgUgXxOjz81DT9bM0j9HzytOpf0cW5ip57BqP4nrqHCslW|charset=UTF-8|short|max=10</rss></div>
== References  ==
== References  ==


References will automatically be added here, see [[Adding References|adding references tutorial]].
<references />
 
<references /><br>  


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Latest revision as of 23:11, 31 January 2021

Original Editor - Kristen Mason Top Contributors - Tomer Yona, Admin, Kristen Mason, Marleen Moll, Kim Jackson, Tarina van der Stockt, WikiSysop, 127.0.0.1, Tony Lowe, Dan Rhon, Evan Thomas, Oyemi Sillo, Kai A. Sigel and Wanda van Niekerk  

Purpose[edit | edit source]

Clinical screening tool for meniscal tears/ lesions.

Patients with suspected meniscal tears experience medial or lateral joint-line discomfort and may have a sense of locking or catching. The Thessaly test is a dynamic reproduction of joint loading in the knee and the theory behind the test is that the knee with a meniscal tear will produce the same symptoms the patient reported. [1]

Knee Joint.jpg[2]

Technique[edit | edit source]

The patient stands flat footed on one leg while the examiner supports the patient by holding their outstretched hands. The patient then flexes the knee to 5° and rotates the femur on the tibia medially and laterally three times, while maintaining the 5° flexion. The uninjured leg is tested first so that the patient may be trained with regard to how to keep the knee in the flexed position. The test is then repeated at 20° flexion. [1] The test is considered positive for a meniscus tear if the patient experiences medial or lateral joint line discomfort or a sense of locking/ catching in the knee.

Thessaly test video provided by Clinically Relevant

Evidence[edit | edit source]

In his original study from 2005, Karachalios [1] found the following statistics for his test: 
Thessaly Test at 5°

Sensitivity Specificity +LR -LR
Injury to Medial Meniscus 0.66 0.96 16.5 0.35
Injury to Lateral Meniscus 0.81 0.91 9 0.21
Combined Injury of ACL and Meniscus 0.65 0.83    -   -


Thessaly Test at 20° 

Sensitivity Specificity +LR -LR
Injury to Medial Meniscus 0.89 0.97 29.67 0.11
Injury to Lateral Meniscus 0.92 0.96 23 0.21
Combined Injury of ACL and Meniscus 0.80 0.91


In more recent studies [3][4][5] from 2015, the Thessaly test has been found to be no better than other tests such as the McMurray test and Apley's Test. When compared to McMurray, medial joint line tenderness and lateral joint line tenderness in a study from 2016, the Thessaly test was found reliable[6].

Sensitivity Specificity +LR -LR
Thessaly Test in recent studies 0.64- 0.66 0.39-0.53 1.37 0.67


In a study by Snoeker et al. from 2015, the Thessaly test had a moderate level of inter-examiner reliability with a kappa of 0.54[4]

Continue reading on Physiopedia:[edit | edit source]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 Karachalios T, Hantes M, Zibis AH, Zachos V, Karantanas AH, Malizos KN. Diagnostic accuracy of a new clinical test (the Thessaly test) for early detection of meniscal tears. J Bone Joint Surg Am. 2005;87(5):955-962.
  2. ↑ Illustration from Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013.
  3. ↑ Goossens P, Keijsers E, Van Geenen RJ, Zijta A, Van den Broek M, Verhagen AP, Scholten-Peeters GG. Validity of the Thessaly test in evaluating meniscal tears compared with arthroscopy: a diagnostic accuracy study. journal of orthopaedic & sports physical therapy. 2015 Jan;45(1):18-24.
  4. ↑ 4.0 4.1 Snoeker BA, Lindeboom R, Zwinderman AH, Vincken PW, Jansen JA, Lucas C. Detecting Meniscal Tears in Primary Care: Reproducibility and Accuracy of 2 Weight-Bearing Tests and 1 Non–Weight-Bearing Test. The Journal of orthopaedic and sports physical therapy. 2015 Sep 1;45(9):693-702.
  5. ↑ Blyth M, Anthony I, Francq B, Brooksbank K, Downie P, Powell A, Jones B, MacLean A, McConnachie A, Norrie J. 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. Health Technology Assessment. 2015.
  6. ↑ Decary, Simon, et al. "Reliability of physical examination tests for the diagnosis of knee disorders: evidence from a systematic review." Manual therapy 26 (2016): 172-182.
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