- 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 appreciatted;
- by altering position of flexion of joint whole of posterior segment of
cartilages is examined from middle to their posterior attachements;
- 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.
