24–5). McMurray test is used to evaluate individuals for tears in the meniscus of the knee. For this type of condition, diagnosis can be made simple by performing what we call the McMurray test., The McMurray test (also known as the McMurray circumduction test) is used to detect internal tears in the knee joint. Technique With the patient supine the examiner holds the knee and palpates the joint line with one hand, thumb on one side and fingers on the other, whilst the other hand holds the sole of the foot and acts to support the limb and provide the required movement through range. If pain is felt by the subject or if a ‘click’ is felt by the subject or examiner, the test is considered positive. By contrast, anterior tears (to the front of the knee) are not easily diagnosed and may require an MRI or arthroscopic investigation to pinpoint the damage. Name. Saunders Elsevier. The tibia is externally rotated while a downward compressive force is applied over the tibia. Knees with associated varus osseous malalignment require a staged corrective osteotomy before the meniscus transplant procedure. Other clinical signs include pain on forced flexion, obvious meniscal displacement during joint compression and flexion and extension, lack of full extension, and a positive, Michael A. Krieves, ... Elizabeth Demers Lavelle, in, Mild effusion is usually present on physical examination, as well as tenderness at the medial or lateral joint line. Patients with tears of the popliteomeniscal attachments may have a positive snapping sign in only the symptomatic knee, which produces posterolateral joint pain. [5], CS1 maint: multiple names: authors list (, https://en.wikipedia.org/w/index.php?title=McMurray_test&oldid=977467694, Creative Commons Attribution-ShareAlike License, This page was last edited on 9 September 2020, at 01:04. Obtain knee radiographs, looking for an osteocartilaginous loose body or other disease. After tear débridement, the perimeniscal or popliteal cyst should be decompressed.
The location of the connection between the meniscal tear and the cyst can often be identified with an arthroscopic probe, trocar, or Wissinger rod (Fig.
Validity of the McMurray's Test and Modified Versions of the Test: A Systematic Literature Review.
most sensitive test for meniscal tear when pain is present; palpate medial and lateral joint lines; McMurray's test . The flexion McMurray test is positive if a painful, palpable click is felt over the respective joint line.6 In comparing physical examination findings to arthroscopic surgical findings, a positive McMurray test is associated with a 66% probability of a meniscal injury,22 and an Apley compression test may support the diagnosis. MRI may be obtained with a proton density weig… Il est positif quand on arrive à reproduire une douleur ou un ressaut palpable lors du mouvement d'extension de genou imprimé par l'examinateur sur un patient en décubitus. According to some sources, the sensitivity of the McMurray test for medial meniscus tears is 53% and the specificity is 59%. Any pain or "clicks" serves as a positive diagnosis of a lateral tear of the meniscus. The examiner’s thumbs should be placed on the femoral condyles, feeling the tibial offset at the level of the joint line (black arrowhead).
Description. A block to passive extension may occur if there is a large, displaced, “bucket-handle” tear. The patellofemoral articulation should be inspected for focal chondral disease, hypermobility, or maltracking. These variations constitute different tests with different statistical performance and should not be confused with the original. Internal rotation is applied to the tibia while the knee is flexed to 40 degrees under a valgus stress (pushing the outside of the knee medially). Required fields are marked *. A comprehensive knee examination is performed that includes assessment of knee motion, patellofemoral indexes, tibiofemoral pain and crepitus, muscle strength, ligament subluxation tests, and gait abnormalities. Yedlinsky, N.T. 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. A thorough history includes assessment of the injury mechanism, initial and residual symptoms, and functional limitations. Repeated McMurray maneuvers may again be gently performed if joint reduction has not occurred. (2008) A meta-analysis examining clinical test utilities for assessing meniscal injury. Patient lies in the supine position with knee completely flexed.
En maintenant cette mise en tension, on amène le genou vers l'extension. JAMA: the Journal of the American Medical Association, Liste des appareils anatomiques et systèmes humains, https://fr.wikipedia.org/w/index.php?title=Test_de_McMurray&oldid=154425033, Portail:Sciences humaines et sociales/Articles liés, licence Creative Commons attribution, partage dans les mêmes conditions, comment citer les auteurs et mentionner la licence. Some studies have advocated concurrent ACL reconstruction and meniscus transplantation.29,84,107 The normal ACL tibia attachment site and the ACL tibial graft tunnel may compromise meniscus transplant tibial fixation. Likewise, external rotation of the leg can be applied to test the posterior portion of the medial meniscus.[2]. The intercondylar notch and anterior joint line should be examined for a displaced bucket-handle tear, cruciate injury, or cyclops lesion. Perform a complete knee examination, checking for point tenderness, effusion, meniscal tear, and joint stability. If the cyst aperture cannot be identified, an 18-gauge spinal needle may be inserted from outside in through the cyst to help decompress or trephinate the cyst cavity. McMurray's test is used to determine the presence of a meniscal tear within the knee. With the affected extremity relaxed the examiner grasps the ankle and palpates the knee while simultaneously rotating the lower leg internally and externally and extending the knee (Fig. The knee is then fully bent and pulled toward outwards in a "knock-kneed" position. Also, the appropriate clinical tests for the ACL, posterior cruciate ligament (PCL), medial, and posterolateral structures are performed. Thank you, {{form.email}}, for signing up.
Place the tested leg back in maximal hip and knee flexion. Alternating working and viewing arthroscopic portals may facilitate access to meniscal tears extending to the mid-body and/or anterior horn.
The Apley compression test, used to assess meniscal integrity, is performed with the patient prone and the examiner’s knee over the patient’s posterior thigh. The posterior drawer is the most sensitive test for evaluating function of the posterior cruciate ligament. This is another of the most well known and most used special tests in orthopedics. Injury of the meniscus can occur acutely with a sudden twisting injury on a partially flexed knee. The modified Gillquist view through the intercondylar notch may permit inspection for tears of the meniscal root or posterior capsulomeniscal junction, as well as so-called “ramp lesions” with concomitant cruciate injury.
These authors described an open approach to repair the popliteomeniscal attachments. Complete radial resection or disruption of the anterior or posterior root attachments may result in significant loss of hoop stresses functionally similar to a subtotal meniscectomy.
>> Return to the list of Common Tests in Orthopaedic Examination of the Knee, Your email address will not be published. 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. https://www.physio-pedia.com/index.php?title=McMurrays_Test&oldid=221092. The, Leitfaden Physiotherapie in der Orthopädie und Traumatologie (Dritte Ausgabe). Le test serait peu sensible [2]. Alternatively, a posteromedial or posterolateral portal can be established for inspection of the posterior knee capsule.
Lateral meniscectomy may quickly progress to diffuse tibiofemoral degenerative changes in high-impact athletes. A thorough history including assessment of prior operative records and current symptoms and functional limitations is taken. Stuart Hershman, MD, is a board-certified spine surgeon. The knee is flexed to 90°, and an external rotation and varus force are applied to the joint. This test is used to determine damage to either the lateral or medial meniscus. Common injury mechanisms are a sudden twist, change in direction (cut), or deep knee flexion. 5.12). This test may produce a lateral palpable snapping sensation, representing an anterior subluxation of the posterior horn of the lateral meniscus with maximum internal rotation. MRI is obtained using proton-density-weighted, high-resolution, fast-spin-echo sequences73,74 to determine the status of the articular cartilage and the previously meniscectomized tibiofemoral compartment. There are several different reported methods of performing McMurrays Test, Reiders method may be the most accurate[6], Sign up to receive the latest Physiopedia news, The content on or accessible through Physiopedia is for informational purposes only.
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