Reflection: 2/12/2020 Hours: 4
Today I had 3 patients in clinic, two with lower back pain and a third with a knee injury.
The patient with a knee injury was a lady in her late 60’s with a slightly high BMI, who had fallen over in the woods and twisted her knee. Judging from the subjective and the patients mechanism of injury I suspected a meniscal tear, so I used the special tests to assess my diagnosis. I performed the Thessaly’s test and joint line tenderness test, both were positive; I did not perform Apley’s test as I find it difficult to perform effectively by applying sufficient pressure.
The Thessaly’s test was previously thought to be the most effective test (Karachalios et al., 2005), however more research research has found that the Thessaly test only has a sensitivity of 64% (Goossens et al., 2015). Many special tests lack validity, therefore caution should be taken when using them to rule out pathologies.
What I was thinking and feeling and what was good or bad:
I felt quite confident with my knowledge surrounding knee injuries and was pleased that I remembered the special tests, it felt good to practice a full assessment and treatment on a new injury. This was good practice for the end of year clinical exam and for when I graduate.
What else I could have done/areas for improvement:
Practice the Apley’s test to become more confident in all special tests. Revise specificity and reliability ratings for other special tests.
Practice more theoretical case studies on the spot, to get used to performing special tests and adapting the objective assessment to tailor it to the individual pathology suspected.
Goossens, P., Keijsers, E., Van Geenen, R. J., Zijta, A., Van den Broek, M., Verhagen, A. P., & Scholten-Peeters, G. G. (2015). Validity of the Thessaly test in evaluating meniscal tears compared with arthroscopy: a diagnostic accuracy study. journal of orthopaedic & sports physical therapy, 45(1), 18-24.
Karachalios, T., Hantes, M., Zibis, A. H., Zachos, V., Karantanas, A. H., & Malizos, K. N. (2005). Diagnostic accuracy of a new clinical test (the Thessaly test) for early detection of meniscal tears. JBJS, 87(5), 955-962.