McMurrays Test
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Introduction
Meniscus tears are the most common injury of the knee.[1] Medial meniscus tears are generally seen more frequently than tears of the lateral meniscus, with a ratio of approximately 2:1.[2]Meniscal tears may occur in acute knee injuries in younger patients or as part of a degenerative process in older individuals. The acute tears frequently result from sports injuries where there is a twisting motion on the partially flexed, weight-bearing knee.[3]
Purpose
McMurray's test is used to determine the presence of a meniscal tear within the knee.
Technique
- Patient Position: Supine lying with knee completely flexed.
- Therapist Position: on the side to be tested.
- Proximal Hand: holds the knee and palpates the joint line, thumb on one side and fingers on the other
- Distal Hand: holds the sole of the foot and acts to support the limb and provide the required movement through range.
- Procedure: From a position of maximal flexion, extend the knee with internal rotation (IR) of the tibia and a VARUS stress, then return to maximal flexion and extend the knee with external rotation (ER) of the tibia and a VALGUS stress.[4][5][6].
The IR of the tibia followed by extension, the examiner can test the entire posterior horn to the middle segment of the meniscus. The anterior portion of the meniscus is not easily tested because the pressure to that part of the meniscus is not as great.
IR of the tibia + Varus stress = lateral meniscus
ER of the tibia + Valgus stress = medial meniscus
Positive findings
Each of these symptoms provides valuable clues about potential damage to the medial or lateral meniscus, which serves as a critical shock-absorbing structure in the knee. Below is an emphasis on their significance:
Pain:
- A sharp, localized pain around the inner (medial) or outer (lateral) side of the knee is a hallmark of meniscal injury.
- Pain may worsen with activities that involve bending, squatting, or twisting, as these motions place stress on the damaged cartilage.
Snapping:
- A sudden sensation of movement or shift within the knee joint, sometimes felt during bending or straightening.
- Often caused by a loose or torn fragment of the meniscus catching on surrounding structures, creating instability.
Audible Clicking:
- A distinct clicking or popping sound during knee movement can indicate mechanical interference within the joint.
- This is frequently associated with a torn flap or displaced fragment of the meniscus getting temporarily caught between the bones.
Locking:
- The inability to fully extend or bend the knee, often accompanied by the feeling that the joint is "stuck."
- Locking is a critical sign of a displaced meniscal tear, such as a bucket-handle tear, where a portion of the cartilage obstructs joint motion.
Evidence
Studies of specificity and sensitivity have demonstrated varied values as a result of poor methodological quality[8] A recent meta-analysis reports sensitivity and specificity to be 70% and 71%.[9]The test has therefore often been reported to be of limited value in current clinical practice. However, if positive findings are grouped with positive findings from other tests, such as joint line tenderness and Apley's test, the test may be more valid. There are several different reported methods of performing McMurrays Test, Reiders method may be the most accurate[10]
References
- ↑ Baker PE, Peckham AC, Pupparo F, Sanborn JC. Review of meniscal injury and associated sports. Am J Sports Med. 1985;13(1):1–4.
- ↑ Campbell SE, Sanders TG, Morrison WB. MR imaging of meniscal cysts: incidence, location, and clinical significance. Am J Roentgenol. 2001;177(2):409–413.
- ↑ Douglas I, McDermott Meniscal tears. Current Orthopaedics. 2006;20:85–94.
- ↑ Magee, D.J Chapter 12: Knee, in Orthopedic Physical Assessment. Pg 791. Saunders Elsevier. Canada. 2008.
- ↑ Piantanida, A.N. Yedlinsky, N.T. Physical examination of the knee, in The Sports Medicine Resource Manual, Editors: Seidenberg, P.H & Beutler, A..I. 2008 Saunders.
- ↑ Waldman,S.D. Painful conditions of the knee, in Pain Management Vol 1., 2007. Saunders.
- ↑ Youtu.Be. Retrieved January 9, 2025, from https://youtu.be/UeWDBV2J0DM?si=NNC8qZX81s-9Jtc6
- ↑ Meserve BB, Cleland JA, Boucher TR. (2008) A meta-analysis examining clinical test utilities for assessing meniscal injury. Clinical Rehabilitation, 22(2), 143-61.
- ↑ Hegedus EJ, Cook C, Hasselblad V, Goode A, McCrory DC. (2007)Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis. Journal of Orthopaedic and Sports Physical Therapy, 37(9), 541-50
- ↑ H Nalwad; M Agarwal; B N Muddu; M Smith; and Mr. J K Borill (2006). McMurrays test revisited: Evaluation of various methods of performing McMurrays test, Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue SUPP_II, 320.