McMurrays Test

Original Editor - Rachael Lowe

Top Contributors - Rachael Lowe, Evan Thomas, Kai A. Sigel, Amanda Ager and Tyler Shultz

Purpose

McMurray's test is used to determine the presence of a meniscal tear within the knee.

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. From a position of maximal flexion, extend the knee with internal rotation (IR) of the tibia and a VARUS stress, then return to maximal flexion and extend the knee with external rotation (ER) of the tibia and a VALGUS stress.[1][2][3] The IR of the tibia followed by extension, the examiner can test the entire posterior horn to the middle segment of the meniscus. The anterior portion of the meniscus is not easily tested because the pressure to that part of the meniscus is not as great.

IR of the tibia + Varus stress = lateral meniscus

ER of the tibia + Valgus stress = medial meniscus

Positive findings:  Pain, snapping, audible clicking or locking can indicate a compromised meniscus.

[4]

Evidence

Studies of specificity and sensitivity have demonstrated varied values as a result of poor methodological quality[5]  A recent meta-analysis reports sensitivity and specificity to be 70% and 71%.[6]The test has therefore often been reported to be of limited value in current clinical practice. However, if positive findings are grouped with positive findings from other tests, such as joint line tenderness and Apley's test, the test may be more valid.  There are several different reported methods of performing McMurrays Test, Reiders method may be the most accurate[7]

References

  1. Magee, D.J Chapter 12: Knee, in Orthopedic Physical Assessment. Pg 791. Saunders Elsevier.  Canada. 2008.
  2. Piantanida, A.N. Yedlinsky, N.T. Physical examination of the knee, in The Sports Medicine Resource Manual, Editors: Seidenberg, P.H & Beutler, A..I. 2008 Saunders. DOI https://doi.org/10.1016/B978-1-4160-3197-0.X1000-2.
  3. Waldman,S.D. Painful conditions of the knee, in Pain Management Vol 1., 2007. Saunders. DOI https://doi.org/10.1016/C2009-1-59662-1.
  4. Physiotutors. McMurray Test⎟Meniscus Damage. Available from: https://www.youtube.com/watch?v=lwDFPAyGGgI
  5. Meserve BB, Cleland JA, Boucher TR. (2008) A meta-analysis examining clinical test utilities for assessing meniscal injury. Clinical Rehabilitation, 22(2), 143-61.
  6. Hegedus EJ, Cook C, Hasselblad V, Goode A, McCrory DC. (2007)Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis. Journal of Orthopaedic and Sports Physical Therapy, 37(9), 541-50
  7. H Nalwad; M Agarwal; B N Muddu; M Smith; and Mr. J K Borill (2006). 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.