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This is Brent of the Brookbush
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Institute and in this video we're going to
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go over the Thessaly's test which might be our most sensitive test for
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meniscus tears. I'm going to have my friend Yvette come out, she's going to help me
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demonstrate. Now we'll say Yvette came in with some knee pain, we want to check out
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to see if her meniscus is in good shape. I know this is a sensitive test so a
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good initial screen, because if we get a negative on this test we're potentially
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in good shape. What I'm going to have you do now Yvette is you're going to stand on one
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leg, now I want you to go down and do a little mini squat for me. So we want
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about twenty-degrees of knee flexion. I'm going to go ahead and let her hold my hands
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because the next thing I'm going to have her do would be very hard to maintain balance,
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but she's going to turn all the way to her right on that leg and all the way to her
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left on that leg. She's going to do this three times in each direction for me. Now
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a positive for this test would be pain or replication of her concordant sign,
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all right being the symptom she came in with. Or if she feels any popping or
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locking or like her knee wants to give, any of that? Nothing. So that was
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all negative, go ahead and relax. Now this test has been
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investigated at five-degrees of knee flexion and zero-degrees of knee flexion,
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which I think it actually might have a different name at zero-degrees, something
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called like the Merck sign, but for whatever reason the the test seems to
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lose sensitivity when we decrease the knee angle below 20-degrees. So keep that
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in mind, make sure somebody gets into a little bit of a squat. My guess is that
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when you get into that little bit of squat we are increasing the amount of
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compression and pressure on the meniscus which would increase the sensitivity of
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this test. Now we do have to keep in mind that in general we kind of suck at
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diagnosing meniscus tears, this is an unfortunate fact. Even though this
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is a more sensitive test there is reason to question some of the research, I did
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mention in the McMurray's test video that I would pair these two tests.
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So I'm going to use this test because it looks like it might
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be the highest sensitivity test, and then the McMurray's test tends to be our most
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specific test. We also have the advantage of McMurray's test being far more
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researched with better research. The two of these combined hopefully help
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increase our diagnostic accuracy a little bit, but I don't have a research
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cluster test to confirm that for you. How I would personally use these is
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I would go okay let's do Thessaly's test again, so let's review maybe we'll do your other
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leg, Alright so go ahead and stand on your affected leg, so the one that
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your came in complaining about, we're going to go ahead and mini squat down to 20-
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degrees, you're going to turn all the way to your right, all the way to your left, you
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can add some joke about dancing in here just to make your
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clients happy. Does that replicate any of your symptoms? (No). Any
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clicking or popping? If we get a negative in this test that's what I'm
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going to weigh more heavily, if I got a positive on this test I probably would
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not weigh it as heavily as the negative. I would then follow this up with
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McMurray's test, and if I did get a positive on this test and then a positive on
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McMurray's too now I'm thinking okay there is a chance of meniscus tear. Of
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course that's probably going to lead me right back into at least trying a few
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sessions of physical therapy, before I would ask for more diagnostic testing
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from perhaps a referral to the physician. So that's it, that's the
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Thessaly's test, 20-degrees of knee flexion. You're just rotating on one leg in a
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semi-squat position. We know that sensitivity decreases with a less knee
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angle, so if for some reason you did have to do this with less knee the angle just
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keep that in mind, and hopefully we get some more research on this particular
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test which seems to have a high likelihood that it could be a really
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good test, we just need some better research. If you have any questions