STUDY DESIGN: Case report. BACKGROUND: Pigmented villonodular synovitis (PVNS) is a rare, benign disorder characterized by idiopathic proliferation affecting the synovium of joints, tendon sheaths, and bursae. Diagnosing PVNS in the knee is difficult because the clinical presentation and symptoms mimic those of more common disorders at the joint, such as internal derangements or arthritis. Operative treatment of PVNS typically consists of arthroscopic or open synovectomy, but no reports of postoperative rehabilitation exist. CASE DESCRIPTION: This case describes the postoperative rehabilitation of a 46-year-old female who had left knee surgery secondary to PVNS. Rehabilitation consisted of combined manual therapy, exercise, and gait training to improve function and gait, and cognitive-behavioral techniques to improve self-efficacy. OUTCOMES: All impairments improved in 2.5 months of physical therapy to normal, and the patient estimated 80% to 90% return to function. DISCUSSION: This patient obtained excellent outcomes in 2.5 months of physical therapy following surgery for PVNS. Although no firm conclusions can be drawn from a case report, this patient responded well to a biopsychosocial approach that combined physical therapy with cognitive-behavioral techniques. LEVEL OF EVIDENCE: Therapy, level 4.

J Orthop Sports Phys Ther. 2008;38(12):790-797, published online 24 October 2008. doi:10.2519/jospt.2008.2934

KEY WORDS: biopsychosocial, cognitive-behavioral, knee, manual therapy, PVNS

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVES: To identify, analyze, and synthesize the literature to determine which physical examination tests, if any, accurately diagnose a torn tibial meniscus. BACKGROUND: Knee pain has a lifetime prevalence of up to 45% and as many as 31% of individuals with knee pain will consult a general practitioner. Roughly 5% of these individuals will undergo a tibial meniscectomy and many more will undergo partial meniscectomy or meniscus repair. Determining which of these individuals is appropriate for surgical consult depends on clinical examination findings. METHODS AND MEASURES: We searched MEDLINE, CINAHL, and SPORTDiscus from 1966 to August 2006 and extracted all English- and German-language studies that reported the diagnostic accuracy of individual physical examination tests for a torn meniscus. We retrieved data regarding true positives, false positives, true negatives, and false negatives to create 2x2 tables for each article and test. Like tests were then subjected to meta-analysis and subanalysis.  Cochran Q test and the I2 statistic were used to examine for the presence of heterogeneity and the extent of the effect of heterogeneity, respectively. A qualitative analysis was also performed using the QUADAS tool. RESULTS: Eighteen studies qualified for the final analyses. Three physical examination tests (McMurray's, Apley's, and joint line tenderness) were examined in more than 7 studies and had enough data to consider meta-analysis. However, study results were heterogeneous. Pooled sensitivity and specificity were 70% and 71% for McMurray's, 60% and 70% for Apley's, and 63% and 77% for joint line tenderness. Large between-study differences could not be explained by prevalence, study quality, or how well an index test was described. CONCLUSIONS: No single physical examination test appears to accurately diagnose a torn tibial meniscus and the value of history plus physical examination is unknown. Differences between studies in diagnostic performance remain unexplained, presumably due to local differences in the way the tests are defined, performed, and interpreted. We recommend a more standardized approach to performing and interpreting these tests and the development of a clinical prediction rule to aid clinicians in the diagnosis of a torn tibial meniscus.

J Orthop Sports Phys Ther. 2007;37(9):541-550, published online 30 May 2007. doi:10.2519/jospt.2007.2560

KEY WORDS: Apley's, diagnosis, joint line tenderness, McMurray's, primary care, tibiofemoral joint

Study Design: Resident’s case problem.
Background: The popularity of weight training has increased dramatically during the past 20 years. With the increase in popularity of weight training, the rate of injury has also increased dramatically. The types of injuries range from benign to life threatening.
Diagnosis: The patient was a 21-year-old woman originally referred for pelvic pain who presented with new complaints of right upper extremity swelling, discomfort, and cyanosis after recently beginning a comprehensive weight-lifting program. Additional signs, including paresthesias, decreased pulses, and venous distension, warranted a timely referral by the physical therapist back to the referring physician.
Discussion: The primary injury in this case report was hypothesized to have been induced by the recent start of a weight-lifting program, with no other significant contributing risk factors. A comprehensive examination by the physical therapist revealed clinical signs of an upper extremity deep vein thrombosis, leading to a same-day referral back to the referring physician. Further research, resulting in a clinical decision rule for upper extremity deep vein thrombosis or estimates of diagnostic accuracy of clinical signs and symptoms, would improve the diagnostic process.

J Orthop Sports Phys Ther. 2006; 36(11):882-886. doi:10.2519/jospt.2006.2250

Key Words: Paget-Schroetter syndrome, primary axillary-subclavian thrombosis, thoracic outlet syndrome, upper extremity deep vein thrombosis