McMurrays Test: Difference between revisions
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== Introduction == | |||
Meniscus tears are the most common injury of the knee.<ref>[https://pubmed.ncbi.nlm.nih.gov/3838420/ Baker PE, Peckham AC, Pupparo F, Sanborn JC. Review of meniscal injury and associated sports. Am J Sports Med. 1985;13(1):1–4.]</ref> Medial meniscus tears are generally seen more frequently than tears of the lateral meniscus, with a ratio of approximately 2:1.<ref>[https://pubmed.ncbi.nlm.nih.gov/11461872/ Campbell SE, Sanders TG, Morrison WB. MR imaging of meniscal cysts: incidence, location, and clinical significance. Am J Roentgenol. 2001;177(2):409–413].</ref>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.<ref>[https://www.sciencedirect.com/science/article/abs/pii/S0268089006000314 Douglas I, McDermott Meniscal tears. Current Orthopaedics. 2006;20:85–94.]</ref> | |||
== Purpose == | == Purpose == | ||
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== Technique == | == Technique == | ||
* Patient Position: Supine lying with knee completely flexed. | * '''Patient Position:''' Supine lying with knee completely flexed. | ||
* Therapist Position: on the side to be tested. | * '''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 | * '''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. | * '''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 <u>internal rotation (IR) of the tibia and a VARUS stress</u>, then return to maximal flexion and extend the knee with <u>external rotation (ER) of the tibia and a VALGUS stress</u>.<ref>Magee, D.J Chapter 12: Knee, in Orthopedic Physical Assessment. Pg 791. Saunders Elsevier. Canada. 2008. </ref><ref>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. DOI <nowiki>https://doi.org/10.1016/B978-1-4160-3197-0.X1000-2</nowiki>.</ref><ref>Waldman,S.D. Painful conditions of the knee, in Pain Management Vol 1., 2007. Saunders. DOI <nowiki>https://doi.org/10.1016/C2009-1-59662-1</nowiki>.</ref>. | * '''Procedure:''' From a position of maximal flexion, extend the knee with <u>internal rotation (IR) of the tibia and a VARUS stress</u>, then return to maximal flexion and extend the knee with <u>external rotation (ER) of the tibia and a VALGUS stress</u>.<ref>Magee, D.J Chapter 12: Knee, in Orthopedic Physical Assessment. Pg 791. Saunders Elsevier. Canada. 2008. </ref><ref>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. DOI <nowiki>https://doi.org/10.1016/B978-1-4160-3197-0.X1000-2</nowiki>.</ref><ref>Waldman,S.D. Painful conditions of the knee, in Pain Management Vol 1., 2007. Saunders. DOI <nowiki>https://doi.org/10.1016/C2009-1-59662-1</nowiki>.</ref>. | ||
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. | 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. | ||
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== Evidence == | == Evidence == | ||
Studies of specificity and sensitivity have demonstrated varied values as a result of poor methodological quality<ref>[http://cre.sagepub.com/cgi/content/abstract/22/2/143 Meserve BB, Cleland JA, Boucher TR. (2008) A meta-analysis examining clinical test utilities for assessing meniscal injury. Clinical Rehabilitation, 22(2), 143-61.]</ref> | Studies of specificity and sensitivity have demonstrated varied values as a result of poor methodological quality<ref>[http://cre.sagepub.com/cgi/content/abstract/22/2/143 Meserve BB, Cleland JA, Boucher TR. (2008) A meta-analysis examining clinical test utilities for assessing meniscal injury. Clinical Rehabilitation, 22(2), 143-61.]</ref> A recent meta-analysis reports sensitivity and specificity to be 70% and 71%.<ref>[http://www.jospt.org/issues/articleID.1307,type.2/article_detail.asp 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]</ref>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|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<ref>[http://proceedings.jbjs.org.uk/cgi/content/abstract/90-B/SUPP_II/320-e 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.]</ref> | ||
== References == | == References == | ||
Revision as of 07:02, 29 November 2022
Original Editor - Rachael Lowe
Top Contributors - Rachael Lowe, Admin, Adrian Shaji, Evan Thomas, Kim Jackson, Kai A. Sigel, Amanda Ager, Tony Lowe, Tyler Shultz, WikiSysop and Wanda van Niekerk
Introduction[edit | edit source]
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[edit | edit source]
McMurray's test is used to determine the presence of a meniscal tear within the knee.
Technique[edit | edit source]
- 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 [edit | edit source]
- Pain
- snapping
- audible clicking
- locking
any of these symptoms can indicate a compromised medial or lateral meniscus.
Evidence[edit | edit source]
Studies of specificity and sensitivity have demonstrated varied values as a result of poor methodological quality[7] A recent meta-analysis reports sensitivity and specificity to be 70% and 71%.[8]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[9]
References[edit | edit source]
- ↑ 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. DOI https://doi.org/10.1016/B978-1-4160-3197-0.X1000-2.
- ↑ Waldman,S.D. Painful conditions of the knee, in Pain Management Vol 1., 2007. Saunders. DOI https://doi.org/10.1016/C2009-1-59662-1.
- ↑ 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.
