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. 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. Joint-line tenderness can be associated with meniscus or collateral ligament injury. 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. 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. It is possible to trap a meniscus fragment and cause the knee to lock completely. 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 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. 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. 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 knee is flexed to 90°, and an external rotation and varus force are applied to the joint.
It can be properly performed only if the patient has a reasonably full and relatively pain-free range of motion. The test is easy to demonstrate but difficult to describe. The basic premise of the McMurray test is that meniscus tears are trapped during certain knee movements, with resultant pain and clunking. 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 test therefore seems to be of limited value in current clinical practice. 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%. In a recent study, clinical test results were compared with arthroscopic and/or arthrotomy findings as reference. 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%. A positive test indicates a tear of the lateral meniscus. A tag, caused by a tear will cause a palpable or even audible click on extension of the knee.
Likewise the medial knee can be stablized and the leg internally rotated as the leg is extended. If pain or a "click" is felt, this constitutes a "positive McMurray test" for a tear in the medial meniscus. The other hand rotates the leg externally while extending the knee. The examiner then places one hand on the lateral side of the knee to stabilize the joint and provide a valgus stress. To perform the test, the knee is held by one hand, which is placed along the joint line, and flexed to ninety degrees while the foot is held by the sole with the other hand. A tear in the meniscus may cause a pedunculated tag of the meniscus which may become jammed between the joint surfaces. It is a rotation test for demonstrating torn cartilage of the knee. The McMurray test, also known as the McMurray circumduction test is used to evaluate individuals for tears in the meniscus of the knee.