Orthopaedic Jobs

McMurray Test: (Br.J. Surg. 1942. 407)



- Discussion:
    - pts knee is acutely and forcibly flexed;
    - to check the medial meniscus examiner palpates posteromedial margin of joint with one hand while grasping the foot w/ other hand;
    - keeping the knee completely flexed, the leg is externally rotated as far as possible and then the knee is slowly extended;
    - lateral meniscus is checked by palpating the posterolateral margin of joint, internally rotating the leg as far as possible, and slowly
         extending the knee while listening and feeling for a click;
    - if cartilage is injured in its posterior section, locking of joint does not occur, and the only indication of the interposition of broken section 
         of cartilage is a momentary loss of control, usually accompanied by comparatively little pain;
    - pt can never localize site of occurrence, usual statement being that there seems to be a sudden loss of power;
    - if cartilage is torn longitudinally signs are at first indefinite, but becomes more obvious if the tear extends into the anterior segment of the 
         cartilage;
    - method of examination by manipulation is of little value when lesion is anterior to the midpoint of joint, area in which clinical signs and 
         symptoms are, as a rule, so well defined that accessory methods of examination are not of paramount importance;
    - in carrying out the manipulation with the patient lying flat, knee is first fully flexed until the heel approaches the buttock;
    - foot is then by grasping the heel and using the forearm as a lever;
    - knee now being steadied by the surgeon's other hand, leg is rotated on the thigh with the knee still in full flexion;
    - during this movement the posterior section of the cartilage is rotated with the head of the tibia, and if the whole cartilage, or any fragment 
         of the posterior section, is loose, this movement produces an appreciable snap in the joint;
    - by external rotation of leg internal cartilage is tested, and by Internal Rotation any abnormality of posterior part of the external cartilage 
         can be appreciated;
    - by altering position of flexion of joint whole of posterior segment of cartilages is examined from middle to their posterior attachments;
    - thus, if the leg is rotated with the knee at right angles cartilages in their mid section come under pressure, but, anterior to this point, the 
         pressure exerted on the cartilage is so diminished that accurate examination is impossible;
    - when loose segment of the cartilage is caught between the bones during rotation, the sliding of the femur over the loose fragment is
         accompanied by a thud or click, which can sometimes be heard but can always be felt;
    - probably the simplest routine is to bring the leg from its position of acute flexion to right angle, whilst foot is retained first in full internal, 
         and then in full external rotation;
    - any abnormality in the cartilage structure in the area under exam will be discovered during the straightening of the femur;
    - if a patient has suffered from repeated lockings of the joint, indicating a lesion of the cartilage in its anterior section, & at same time a 
         definite click can be produced from the same cartilage posteriorly, it is evident that a Bucket Handle Tears is present;

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Paradoxical phenomena of the McMurray test. An arthroscopic investigation.

A review of the McMurray test: definition, interpretation, and clinical usefulness.

Prospective evaluation of the McMurray test.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, April 30, 2012 2:27 pm