The Diagnostic Validity of Clinical Tests in Temporomandibular Internal Derangement: A Systematic Review and Meta-analysis

Author:

Chaput Ève1,Gross Anita2,Stewart Ryan1,Nadeau Gordon1,Goldsmith Charlie H.34

Affiliation:

1. School of Physiotherapy, University of Western Ontario, London, Ont.

2. School of Rehabilitation Science, McMaster University, Hamilton, Ont.

3. Faculty of Health Science, Simon Fraser University, Burnaby, B.C.

4. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont.

Abstract

Purpose: To assess the diagnostic validity of clinical tests for temporomandibular internal derangement relative to magnetic resonance imaging (MRI). Methods: MEDLINE and Embase were searched from 1994 through 2009. Independent reviewers conducted study selection; risk of bias was assessed using Quality Assessment of studies of Diagnostic Accuracy included in Systematic reviews (QUADAS); ≥9/14) and data abstraction. Overall quality of evidence was profiled using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Agreement was measured using quadratic weighted kappa (κw). Positive (+) or negative (−) likelihood ratios (LR) with 95% CIs were calculated and pooled using the DerSimonian–Laird method and a random-effects model when homogeneous (I2≥0.40, Q-test p≤0.10). Results: We selected 8 of 36 studies identified. There is very low quality evidence that deflection (+LR: 6.37 [95% CI, 2.13–19.03]) and crepitation (LR:5.88 [95% CI, 1.95–17.76]) as single tests and crepitation, deflection, pain, and limited mouth opening as a cluster of tests are the most valuable for ruling in internal derangement without reduction (+LR:6.37 [95% CI, 2.13–19.03]), (−LR:0.27 [95% CI, 0.11–0.64]) while the test cluster click, deviation, and pain rules out internal derangement with reduction (−LR: 0.09 [95% CI, 0.01–0.72]). No single test or cluster of tests was conclusive and of significant value for ruling in internal derangement with reduction. Conclusions: Findings of this review will assist clinicians in deciding which diagnostic tests to use when internal derangement is suspected. The literature search revealed a lack of high-quality studies; further research with adequate description of patient populations, blinded assessments, and both sagittal and coronal MRI planes is therefore recommended.

Publisher

University of Toronto Press Inc. (UTPress)

Subject

Physical Therapy, Sports Therapy and Rehabilitation

Reference36 articles.

1. Magnetic resonance imaging findings of internal derangement and effusion in patients with unilateral temporomandibular joint pain

2. Gross, AR (1994).The diagnostic validity of clinical tests in temporomandibular disorders: A systematic overview and meta-analysis. [dissertation].Hamilton (ON):McMaster University

3. Oral health status in the United States: temporomandibular disorders

4. Epidemiologic studies of mandibular dysfunction: A critical review

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