Test: McMurray's Test

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Background/Purpose

Purpose and History
McMurray's Test is a common orthopedic clinical examination used to assess for tears of the menisci (singular: meniscus) within the knee joint. The menisci are C-shaped cartilage structures that sit between the femur (thigh bone) and the tibia (shin bone), acting as shock absorbers and contributing to knee stability.

The test is named after Thomas P. McMurray, a British orthopedic surgeon who described the maneuver in 1941. At a time when arthroscopy was not yet a widely available diagnostic tool, clinical tests like McMurray's were crucial for identifying internal derangements of the knee. While modern imaging techniques such as MRI are now the gold standard for confirming meniscal tears, McMurray's Test remains a valuable tool for clinicians due to its simplicity, low cost, and ability to provide immediate clinical suspicion.

Why Use This Test?
McMurray's Test is utilized when a patient presents with symptoms suggestive of a meniscal injury. These symptoms commonly include:

Knee pain: Often localized to the joint line.
Clicking or popping sensation: Especially during movement.
Catching or locking: The knee may "give way" or become temporarily stuck.
Swelling: May be present, especially after activity.
Limited range of motion: Difficulty fully straightening or bending the knee.
The test helps to differentiate meniscal pathology from other knee conditions that may present with similar symptoms, such as ligamentous injuries, patellofemoral pain syndrome, or osteoarthritis. A positive McMurray's Test, in conjunction with the patient's history and other clinical findings, significantly increases the likelihood of a meniscal tear, guiding further diagnostic steps and treatment decisions.

Procedure

McMurray's Test is performed with the patient supine (lying on their back) on an examination table. The examiner stands at the side of the affected knee.

To test the Medial Meniscus:

Flexion and Valgus Stress: The examiner grasps the patient's heel with one hand and places the other hand on the knee joint line, specifically palpating the medial joint line.
External Rotation and Extension: The knee is fully flexed, and the examiner applies a valgus (outward) stress to the knee while simultaneously externally rotating the tibia.
Slow Extension: While maintaining the valgus stress and external rotation, the knee is slowly extended. The examiner is feeling and listening for a "click," "clunk," or "pop" and observing for any pain at the medial joint line.
To test the Lateral Meniscus:

Flexion and Varus Stress: The examiner grasps the patient's heel with one hand and places the other hand on the knee joint line, specifically palpating the lateral joint line.
Internal Rotation and Extension: The knee is fully flexed, and the examiner applies a varus (inward) stress to the knee while simultaneously internally rotating the tibia.
Slow Extension: While maintaining the varus stress and internal rotation, the knee is slowly extended. The examiner is feeling and listening for a "click," "clunk," or "pop" and observing for any pain at the lateral joint line.
Key points for proper technique:

Controlled Movement: The extension should be slow and controlled to allow for detection of subtle clicks or catches.
Palpation: Careful palpation of the joint line is crucial to localize pain and feel for mechanical signs.
Comparison: It is often helpful to compare the findings to the uninjured knee.
How to Interpret the Test
A positive McMurray's Test is indicated by:

A palpable or audible click, clunk, or pop: This suggests the torn meniscal fragment is being caught between the femoral condyle and the tibial plateau as the knee extends.
Reproduction of the patient's pain: Pain specifically localized to the medial or lateral joint line during the maneuver.
A "giving way" or locking sensation: Though less common during the test itself, this may indicate a significant tear.
Specificity of the findings:

A click/pain with external rotation and valgus stress during extension suggests a tear of the medial meniscus.
A click/pain with internal rotation and varus stress during extension suggests a tear of the lateral meniscus.
It is important to note that a positive McMurray's Test is suggestive, but not definitive, of a meniscal tear. False positives can occur, and some meniscal tears may not elicit a positive test. Therefore, the results of the McMurray's Test should always be interpreted in conjunction with the patient's history, other physical examination findings, and if necessary, diagnostic imaging (e.g., MRI).
Performed: Unilaterally

Dialog

Patient Position: Patient lies on their back. Medial Meniscus Test: Fully flex the knee. Grasp the heel and externally rotate the foot. Apply valgus stress to the knee (push the knee inward). Slowly extend the knee, feeling and listening for a click/pop, and observing for medial joint line pain. Lateral Meniscus Test: Fully flex the knee. Grasp the heel and internally rotate the foot. Apply varus stress to the knee (push the knee outward). Slowly extend the knee, feeling and listening for a click/pop, and observing for lateral joint line pain.

Criteria

• No pain
• No clicking,, catching, popping

Measurement

LOINC Code

Scale/Grading

selection range; grade - LOINC ID
Option - Value option selection range; grade - LOINC IDPass ; Pass - Fail ; Fail -