Clinical tests of running injuries
and their diagnostic value
Hans Peter Jensen,
Head of Sportstrauma Clinic, Dept of Orthopaedic Surgery
Aalborg Universityhospital
Frequent running injuries
Injury
n
% of 2002
Patellofemoral pain syndrome - PFPS
331
16%
Iliotibial band friction syndrome - ITBFS
168
8%
Plantar fasciitis
158
8%
Meniscal injuries
100
5%
Medial tibial stress syndrome - MTSS
99
5%
Patellar tendinitis
96
5%
Achilles tendinitis
96
5%
Gluteus medius injuries
70
3%
Stress fracture – tibia
67
3%
Taunton J E et al., Br J Sports Med 2002;36:95-101
Likelihood ratio
– value of a diagnostic test
 Sensitivity = True test positive/number of diseased
 Specificity = True test negative/number of healthy
 LK+ = Sensiticvty/(1-specificity)
 <2: poor value
2-5: moderate
>5: good value
 LK- = (1 – sensitivity)/specificity
 0,5-1: poor value
>0,5: good value
Patellofemoral pain syndrome
 Vastus medialis coordination test (Souza 1997)
 LR+ = 2.26
LR- = 0.90
 Patellar apprehension test (Reider 1999)
 LR+ = 2.26
LR- = 0.79
 Eccentric step test (Selfe 2001)
 LR+ = 2.34
LR- = 0.71
Nijs J et al. Manual Therapy 2006;11:69-77
Iliotibial band friction syndrome
 Ober test
 Papers on likelihood ratios (LR+/LR-)
 Noble test
 Papers on likelihood ratios (LR+/LR-)
Plantar fasciitis
 Windlass test
 LR+ = 0.31/1-1
LR- = 0.69
De Garceau D et al. Foot Ankle Int. 2003;24:251–255
Meniscial injuries
 McMurray test
 LR+ = 8
LR- = 0,55
 Thessaly Test
 LR+ = 23
LR- = 0,08
Karachalios T, J Bone Joint Surg Am. 2005;87(5):955-962
Medial tibial stress syndrome
 Shin palpation test
 LR+ = 3.38
LR- = 0,73
 Shin oedema test
 LR+ = 7,26
LR- = 0,09
 Combined
 LR+ = 9,94
LR- = <0,01
Newman P et al. Br J Sports Med 2012;46:861-864
Patellar tendinitis
 Standing active quadriceps test
 No papers on likelihood ratios
 Passive extension flexion test
 No papers om likelihood ratios
Achilles tendinitis
 Palpation of the tendon: tender, increased size, crepitation
and elevated skin temperature.
 Thomson squeese test to exclude rupture
Gluteus medius injuries
 Trendelenburg test
 LR+ = 6,83
LR- = 0,25
 Resisted hip abduction test
 LR+ = 5,50
LR- = 0,37
Rieman MP et al. Br J Sports Med 2013;47:893-902
Stress fracture
 Patellar-pubic percussion test
 LR+ = 6.11
LR- = 0.07
Rieman MP et al. Br J Sports Med 2013;47:893-902
Conclusion
 A valid diagnosis is rarely based on one single clinical test.
 Meticulous patient history is mandatory
 Combination of several tests often needed including
judgement of body posture
 Radiograms, CT-scan, MRI, Scintigraphy and Ultrasonography
may be needed
Thank you for your attention