A positive test indicates a tear of the lateral meniscus. The other leg must also be checked for completeness because clicks can arise from normal tendon movement.Īccording to some sources, the sensitivity of the McMurray test for medial meniscus tears is 53% and the specificity is 59%. In a recent study, clinical test results were compared with arthroscopic and/or arthrotomy findings as reference. The clinical test had a sensitivity of 58.5%, a specificity of 93.4%, and the predictive value of a positive result was 82.6%. The test therefore seems to be of limited value in current clinical practice. Hawker, in Fam's Musculoskeletal Examination and Joint Injection Techniques (Second Edition), 2010 Meniscal Tests The McMurray test is named after Thomas Porter McMurray, a British orthopedic surgeon from the late nineteenth and early twentieth century.Hans J. The basic premise of the McMurray test is that meniscus tears are trapped during certain knee movements, with resultant pain and clunking. The test is easy to demonstrate but difficult to describe. It can be properly performed only if the patient has a reasonably full and relatively pain-free range of motion. The knee is flexed to 90°, and an external rotation and varus force are applied to the joint. The applied forces are maintained while the knee is flexed smoothly to a position of maximum flexion, and then the force is smoothly changed from a varus and external rotation force to an internal rotation and valgus force while the knee is extended from the fully flexed position. The process is then reversed and is usually repeated several times in smooth succession, until the examiner is satisfied that the entire range has been thoroughly assessed. It may be helpful to consider that the heel describes a large “U,” with the toes always pointing toward the center of the “U.” During the test, the fingers of the examiner’s free hand are placed along the medial and lateral joint lines to palpate any abnormal snapping or clicking that might be caused by meniscus pathology. A positive test is indicated by pain in association with a clunk, as the torn meniscus fragment is manipulated between the femur and tibia. It is possible to trap a meniscus fragment and cause the knee to lock completely. Although it is generally thought that the medial meniscus is assessed during the valgus and internal rotation position of the tibia, and the lateral meniscus during the opposite phase of the test, this is probably an oversimplification. The area of pain and clunking is more reliable in pointing out the location of pathology in conjunction with other signs and symptoms ( Figure 6-37).Īpley distraction and grinding (compression) tests. Joint-line tenderness can be associated with meniscus or collateral ligament injury. The concept behind the Apley test is that ligaments usually are painful when stressed in distraction, whereas pain involving the meniscus is felt with compression. With the patient in the prone position, the knee flexed 90°, and the femur stabilized with one hand, distraction is applied with the other hand by pulling upward on the ankle while rotating medially and laterally. MCMURRAY MENISCUS TEST SENSITIVITY FREE.MCMURRAY MENISCUS TEST SENSITIVITY FULL.
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