Clinical utility of the Duncan-Ely test for rectus femoris dysfunction during the swing phase of gait

Marks, MC; Alexander, Joshua; Sutherland, David H.; Chambers, HG

doi:10.1017/s0012162203001415

Cited by 28 publications

(32 citation statements)

References 8 publications

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“…Indications for RFT are a positive Duncan‐Ely test and diminution of at least 15° of the total range of knee flexion during the swing phase . A study revealed that the Duncan‐Ely test had a good positive predictive value for rectus femoris dysfunction during gait . Therefore, a positive result in the Duncan‐Ely test might be a surgical indication for RFT.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, a positive result in the Duncan‐Ely test might be a surgical indication for RFT. However, Marks et al . reported that the sensitivity of the Duncan‐Ely test ranged from 56% to 59%, and the specificity ranged from 64% to 85%.…”

Section: Discussionmentioning

confidence: 99%

“…The test is considered positive if the patient simultaneously flexes their ipsilateral hip or if resistance is felt by the examiner during passive knee flexion . A positive test result reflects the velocity‐dependent spasticity of the rectus femoris muscle during the rapid movement test as well as muscle contracture during the slow movement test . Although a previous study reported that the hip rise was not necessarily specific for rectus femoris spasticity and that it might be due to the electromyographic response in both the rectus femoris and the iliopsoas, the Duncan‐Ely test is a helpful predictor of rectus femoris dysfunction during gait and of outcomes in children being considered for RFT surgery .…”

mentioning

confidence: 99%

“…A positive test result reflects the velocity‐dependent spasticity of the rectus femoris muscle during the rapid movement test as well as muscle contracture during the slow movement test . Although a previous study reported that the hip rise was not necessarily specific for rectus femoris spasticity and that it might be due to the electromyographic response in both the rectus femoris and the iliopsoas, the Duncan‐Ely test is a helpful predictor of rectus femoris dysfunction during gait and of outcomes in children being considered for RFT surgery . The test is easy to perform; however, the test method is vague in terms of the knee flexion velocity, and the results are based on the examiners’ judgements and are therefore subjective.…”

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confidence: 99%

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Reliability and validity of the Duncan‐Ely test for assessing rectus femoris spasticity in patients with cerebral palsy

Lee

Sung

Chung

et al. 2015

Develop Med Child Neuro

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3DGAThree-dimensional gait analysis ICC Intraclass correlation coefficient RFT Rectus femoris transfer ROC Receiver operator characteristics AIM The aim of this study was to clarify the method of the Duncan-Ely test and to estimate its interobserver reliability and validity by comparing it with three-dimensional gait analysis (3DGA). METHOD This study included 36 consecutive ambulatory patients with cerebral palsy (CP)who underwent preoperative 3DGA. The Duncan-Ely test was performed during three different velocities (slow, gravity, and fast). The interobserver reliability was assessed by three examiners. The results of the test were compared with kinematic variables derived from the gait analysis to assess the sensitivity and specificity of the test. The cut-off value was determined at the point of trade-off between the highest sensitivity and specificity. RESULTSThe intraclass correlation coefficient measuring interobserver reliability of the Duncan-Ely test was greatest during fast velocity (0.819). The sensitivity and specificity of the test during gravity velocity for knee range of motion total were 63.0% and 100% respectively, with a cut-off value of 78.3°. The sensitivity and specificity of the test during fast velocity for knee range of motion total were 66.7% and 100% respectively, with a cut-off value of 65°. INTERPRETATIONThe Duncan-Ely test shows excellent reliability in fast knee-flexion velocity, and good sensitivity and specificity compared with 3DGA during physical examination as a preoperative assessment of rectus femoris spasticity in patients with CP.Stiff-knee gait, which is defined as a restricted arc in knee motion during swing, 1 is a common gait disorder in ambulatory patients with cerebral palsy (CP), regardless of the anatomical type of CP.2 Stiff-knee gait results in foot clearance problems and reduces gait velocity and step length. Some patients complain of their shoes wearing out rapidly. Although there is still controversy, 3 it is now widely accepted that one of the causes of stiff-knee gait in patients with CP is spasticity of the rectus femoris. [4][5][6][7] Since rectus femoris transfer (RFT) has been recommended for restoring knee motion during the swing phase, it is now the standard surgical treatment for stiff-knee gait in patients with CP and is frequently performed as part of a single-event multilevel surgery. 1,5,8,9 Before single-event multilevel surgery, a physical examination is essential to assess the patient's physical status. The Duncan-Ely test, among others, has been recommended as a clinical tool for assessing rectus femoris spasticity. 10 In the classic Duncan-Ely test, the examiner passively flexes the knee rapidly while the patient lies prone in a relaxed state. The test is considered positive if the patient simultaneously flexes their ipsilateral hip or if resistance is felt by the examiner during passive knee flexion.10,11 A positive test result reflects the velocitydependent spasticity of the rectus femoris muscle during the rapid movement test as well as mu...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Reliability and validity of the Duncan‐Ely test for assessing rectus femoris spasticity in patients with cerebral palsy

Lee

Sung

Chung

et al. 2015

Develop Med Child Neuro

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“…General visualization of the patellar movement through flexion extension may be helpful in detecting malalignment if there is a "J sign" [80,81] as result of lateral retinacular tightness or medial retinacular weakness. Decreased quadriceps flexibility, specifically rectus femoris tightness, can be assessed by using the Ely Test [82]. …”

Section: Discussionmentioning

confidence: 99%

Patellofemoral pain syndrome (PFPS): a systematic review of anatomy and potential risk factors

Waryasz

McDermott

2008

Dyn Med

194

157

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Background: Patellofemoral Pain Syndrome (PFPS), a common cause of anterior knee pain, is successfully treated in over 2/3 of patients through rehabilitation protocols designed to reduce pain and return function to the individual. Applying preventive medicine strategies, the majority of cases of PFPS may be avoided if a pre-diagnosis can be made by clinician or certified athletic trainer testing the current researched potential risk factors during a Preparticipation Screening Evaluation (PPSE). We provide a detailed and comprehensive review of the soft tissue, arterial system, and innervation to the patellofemoral joint in order to supply the clinician with the knowledge required to assess the anatomy and make recommendations to patients identified as potentially at risk. The purpose of this article is to review knee anatomy and the literature regarding potential risk factors associated with patellofemoral pain syndrome and prehabilitation strategies. A comprehensive review of knee anatomy will present the relationships of arterial collateralization, innervations, and soft tissue alignment to the possible multifactoral mechanism involved in PFPS, while attempting to advocate future use of different treatments aimed at non-soft tissue causes of PFPS.

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Anatomical landmarks for ultrasound‐guided rectus femoris diagnostic nerve block in post‐stroke spasticity

Facciorusso

Spina

Gasperini

et al. 2023

Australas J Ultrason Med

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Introduction/PurposeTo determine the location of the rectus femoris (RF) motor branch nerve, as well as its coordinates with reference to anatomical and ultrasound landmarks.MethodsThirty chronic stroke patients with stiff knee gait (SKG) and RF hyperactivity were included. The motor nerve branch to the RF muscle was identified medially to the vertical line from anterior superior iliac spine and the midpoint of the superior margin of the patella (line AP) and vertically to the horizontal line from the femoral pulse and its intersection point with the line AP (line F). The point of the motor branch (M) was located with ultrasound, and nerve depth and subcutaneous tissue thickness (ST) were calculated.ResultsThe coordinates of the motor branch to the RF were 2.82 (0.47) cm medially to the line AP and 4.61 (0.83) cm vertically to the line F. Nerve depth and subcutaneous tissue thickness were 2.71 (0.62) cm and 1.12 (0.75) cm, respectively.ConclusionThe use of specific coordinates may increase clinicians' confidence when performing RF motor nerve block. This could lead to better decision‐making when assessing SKG in chronic stroke patients.

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Clinical utility of the Duncan-Ely test for rectus femoris dysfunction during the swing phase of gait

Cited by 28 publications

References 8 publications

Reliability and validity of the Duncan‐Ely test for assessing rectus femoris spasticity in patients with cerebral palsy

Reliability and validity of the Duncan‐Ely test for assessing rectus femoris spasticity in patients with cerebral palsy

Patellofemoral pain syndrome (PFPS): a systematic review of anatomy and potential risk factors

Anatomical landmarks for ultrasound‐guided rectus femoris diagnostic nerve block in post‐stroke spasticity

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