McMurray test

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The McMurray test, also known as the McMurray circumduction test is used to evaluate individuals for tears in the meniscus of the knee. [1] A tear in the meniscus may cause a pedunculated tag of the meniscus which may become jammed between the joint surfaces.

To perform the test, the knee is held by one hand, which is placed along the joint line, and flexed to complete flexion while the foot is held by the sole of the foot with the other hand. The examiner then rotates the leg internally while extending the knee to 90 degrees of flexion. If a "thud" or "click" is felt along with pain, this constitutes a "positive McMurray test" for a tear in the posterior portion of the lateral meniscus. Likewise, external rotation of the leg can be applied to test the posterior portion of the medial meniscus. [2]

The McMurray test is named after Thomas Porter McMurray, [2] a British orthopedic surgeon from the late nineteenth and early twentieth century who was the first to describe this test. The description of the test has since been altered from the original by various authors. [3] Most commonly, varus and valgus stress to the knee is added. These variations constitute different tests with different statistical performance and should not be confused with the original.

According 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. [4] 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%. A more recent study showed a 97% specificity for meniscal tears. [5]

See also

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Meniscus (anatomy) Menisci of knee joint

A meniscus is a crescent-shaped fibrocartilaginous anatomical structure that, in contrast to an articular disc, only partly divides a joint cavity. In humans they are present in the knee, wrist, acromioclavicular, sternoclavicular, and temporomandibular joints; in other animals they may be present in other joints.

Plantaris muscle muscle

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The Apley grind test or Apley test is used to evaluate individuals for problems in the meniscus of the knee. The Apley grind test has a reported sensitivity of 97% and a specificity of 87%.

A meniscus transplant or meniscal transplant is a transplant of the meniscus of the knee, which separates the thigh bone (femur) from the lower leg bone (tibia). The worn or damaged meniscus is removed and is replaced with a new one from a donor. The meniscus to be transplanted is taken from a cadaver, and, as such, is known as an allograft. Meniscal transplantation is technically difficult, as it must be sized accurately for each person, positioned properly and secured to the tibial plateau. As of 2012, only a few surgeons have significant volume of experience in meniscus transplantation worldwide.

Lateral meniscus

The lateral meniscus is a fibrocartilaginous band that spans the lateral side of the interior of the knee joint. It is one of two menisci of the knee, the other being the medial meniscus. It is nearly circular and covers a larger portion of the articular surface than the medial. It can occasionally be injured or torn by twisting the knee or applying direct force, as seen in contact sports.

The knee examination, in medicine and physiotherapy, is performed as part of a physical examination, or when a patient presents with knee pain or a history that suggests a pathology of the knee joint.

Anterior cruciate ligament injury ligament injury near the knee

Anterior cruciate ligament injury is when the anterior cruciate ligament (ACL) is either stretched, partially torn, or completely torn. The most common injury is a complete tear. Symptoms include pain, a popping sound during injury, instability of the knee, and joint swelling. Swelling generally appears within a couple of hours. In approximately 50% of cases, other structures of the knee such as surrounding ligaments, cartilage, or meniscus are damaged.

Unhappy triad medical condition

The unhappy triad, also known as a blown knee among other names, is an injury to the anterior cruciate ligament, medial collateral ligament, and meniscus. Analysis during the 1990s indicated that this 'classic' O'Donoghue triad is actually an unusual clinical entity among athletes with knee injuries. Some authors mistakenly believe that in this type of injury, "combined anterior cruciate and medial collateral ligament disruptions that were incurred during athletic endeavors" always present with concomitant medial meniscus injury. However, the 1990 analysis showed that lateral meniscus tears are more common than medial meniscus tears in conjunction with sprains of the ACL.

Straight leg raise

The straight leg raise, also called Lasègue's sign, Lasègue test or Lazarević's sign, is a test done during a physical examination to determine whether a patient with low back pain has an underlying herniated disc, often located at L5.

Tear of meniscus Rupturing of the fibrocartilage strips in the knee called menisci

A tear of a meniscus is a rupturing of one or more of the fibrocartilage strips in the knee called menisci. When doctors and patients refer to "torn cartilage" in the knee, they actually may be referring to an injury to a meniscus at the top of one of the tibiae. Menisci can be torn during innocuous activities such as walking or squatting. They can also be torn by traumatic force encountered in sports or other forms of physical exertion. The traumatic action is most often a twisting movement at the knee while the leg is bent. In older adults, the meniscus can be damaged following prolonged 'wear and tear'. Especially acute injuries can lead to displaced tears which can cause mechanical symptoms such as clicking, catching, or locking during motion of the joint. The joint will be in pain when in use, but when there is no load, the pain goes away.

This test is one of the three major tests for assessing anterior cruciate injury or laxity, the other two being the anterior drawer and Lachman test. However, unlike the other two, it tests for instability, an important determinant as to how the knee will function. In fact, it is instability, not simply the injury to the anterior cruciate ligament itself, that places the menisci at future risk, and gives rise to the feeling that the "knee is not secure" or "may give out".

In medicine, joint locking is a symptom of pathology in a joint. It is a complaint by a person when they are unable to fully flex or fully extend a joint. This term is also used to describe the mechanism of lower limb joints held in full extension without much muscular effort when a person is standing.

Knee pain

Knee pain is pain in or around the knee.

Posterolateral corner injuries of the knee are injuries to a complex area formed by the interaction of multiple structures. Injuries to the posterolateral corner can be debilitating to the person and require recognition and treatment to avoid long term consequences. Injuries to the PLC often occur in combination with other ligamentous injuries to the knee; most commonly the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL). As with any injury, an understanding of the anatomy and functional interactions of the posterolateral corner is important to diagnosing and treating the injury.

Medial knee injuries

Medial knee injuries are those to the medial side – the inside of the knee – are the most common. The medial ligament complex of the knee is composed of the superficial medial collateral ligament (sMCL), deep medial collateral ligament (dMCL), and the posterior oblique ligament (POL). These ligaments have also been called the medial collateral ligament (MCL), tibial collateral ligament, mid-third capsular ligament, and oblique fibers of the sMCL, respectively. This complex is the major stabilizer of the medial knee. Injuries to the medial side of the knee are most commonly isolated to these ligaments. A thorough understanding of the anatomy and function of the medial knee structures, along with a detailed history and physical exam, are imperative to diagnosing and treating these injuries.

Posterior cruciate ligament injury

The function of the posterior cruciate ligament (PCL) is to prevent the femur from sliding off the anterior edge of the tibia and to prevent the tibia from displacing posterior to the femur. Common causes of PCL injuries are direct blows to the flexed knee, such as the knee hitting the dashboard in a car accident or falling hard on the knee, both instances displacing the tibia posterior to the femur.

References

  1. Solomon, D. H.; Simel, D. L.; Bates, D. W.; Katz, J. N.; Schaffer, J. L. (2001). "The rational clinical examination. Does this patient have a torn meniscus or ligament of the knee? Value of the physical examination". JAMA: The Journal of the American Medical Association. 286 (13): 1610–1620. doi:10.1001/jama.286.13.1610. PMID   11585485.
  2. 1 2 McMurray, T.P. (1942). "The semilunar cartilages". British Journal of Surgery. 29 (116): 407–414. doi:10.1002/bjs.18002911612.
  3. Stratford, Paul W.; Binkley, Jill (1995). "A Review of the McMurray Test: Definition, Interpretation, and Clinical Usefulness". Journal of Orthopaedic & Sports Physical Therapy. 22 (3): 116–120. doi:10.2519/jospt.1995.22.3.116. PMID   8535469.
  4. Corea JR, Moussa M, al Othman A (1994). "McMurray's test tested". Knee Surg Sports Traumatol Arthrosc . 2 (2): 70–72. doi:10.1007/BF01476474. PMID   7584186.
  5. Jackson JL, O’Malley PG, Kroenke K. Evaluation of acute knee pain in primary care. Ann Intern Med. 2003;139:575-88. PMID   14530229