The McMurray Maneuver

The McMurray Maneuver—often interchangeably referred to as the McMurray Test—is a clinical examination technique used primarily to detect tears in the knee’s meniscal cartilage.

Purpose of the McMurray Maneuver

• Detect Meniscal Tears: Helps identify cartilage damage in the knee joint.
• Assess Knee Stability: Determines if the meniscus is causing mechanical symptoms like locking or clicking.
• Guide Further Imaging: If positive, additional tests like MRI or arthroscopy may be needed for confirmation

Patient Positioning and Examiner Technique

1.Patient Position:

• The patient lies supine (on their back) on an examination table.
• The knee to be tested is flexed maximally (often to about 90 degrees) to engage and stress the meniscus.

2.Examiner’s Hand Placement:

• Proximal (stabilizing) Hand: The examiner places one hand on the joint line of the knee to palpate for any irregularities or tenderness along the meniscal borders.
• Distal Hand: The other hand grasps the patient’s heel (or the lower leg) to control and manipulate the tibia during the test.

3.Performing the Maneuver:

For the Medial Meniscus:

• The examiner applies a valgus stress (a force that pushes the knee medially) while externally rotating the tibia.
• The knee is then slowly extended from the flexed position while maintaining the stress.
• This action compresses the medial meniscus between the tibial plateau and the femur.

For the Lateral Meniscus:

• Conversely, to evaluate the lateral meniscus, a varus stress (a force pushing the knee laterally) is applied while internally rotating the tibia.
• Again, the knee is gradually extended, placing stress on the lateral meniscus.

4.Interpreting the Findings:

• Click or Pop: An audible or palpable clicking sound during the maneuver is considered a positive sign.
• Pain or Locking: The patient may report sharp, localized pain at the joint line or describe the knee “locking” during extension, which are further indicators of a meniscal tear.
• Importantly, the test allows the examiner to note which compartment of the knee is affected based on whether the symptoms arise with valgus/external rotation (medial meniscus) or varus/internal rotation (lateral meniscus).

Clinical Considerations

• Sensitivity and Specificity: While the McMurray maneuver is a common and simple bedside test, studies have noted variable sensitivity and specificity. This means that although it can be a helpful preliminary screening tool, it is often supplemented with imaging—such as MRI—to confirm the diagnosis.
• Technique Variability: The test’s diagnostic accuracy can depend on the examiner’s experience and the patient’s body habitus or pain tolerance. A careful, deliberate technique maximizes the chances of eliciting a positive finding when a tear is present.
• Complementary Tests: Other clinical tests, such as Apley’s compression Test or the Thessaly Test, are sometimes used alongside the McMurray maneuver to provide a more comprehensive evaluation of meniscal integrity.

Positive findings 

Each of these symptoms provides valuable clues about potential damage to the medial or lateral meniscus, which serves as a critical shock-absorbing structure in the knee. Below is an emphasis on their significance:

1.Pain:

• A sharp, localized pain around the inner (medial) or outer (lateral) side of the knee is a hallmark of meniscal injury.
• Pain may worsen with activities that involve bending, squatting, or twisting, as these motions place stress on the damaged cartilage.

2.Snapping:

• A sudden sensation of movement or shift within the knee joint, sometimes felt during bending or straightening.
• Often caused by a loose or torn fragment of the meniscus catching on surrounding structures, creating instability.

3.Audible Clicking:

• A distinct clicking or popping sound during knee movement can indicate mechanical interference within the joint.
• This is frequently associated with a torn flap or displaced fragment of the meniscus getting temporarily caught between the bones.

4.Locking:

• The inability to fully extend or bend the knee, often accompanied by the feeling that the joint is “stuck.”
• Locking is a critical sign of a displaced meniscal tear, such as a bucket-handle tear, where a portion of the cartilage obstructs joint motion.

REFERENCES

1. American Academy of Orthopaedic Surgeons. Meniscus tears https://orthoinfo.aaos.org/en/diseases–conditions/meniscus-tears/.
2. 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.
3. 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
4. Blyth M, Anthony I, Francq B, et. al. Diagnostic accuracy of the Thessaly test, standardised clinical history and other clinical examination tests (Apley’s, McMurray’s and joint line tenderness) for meniscal tears in comparison with magnetic resonance imaging diagnosis (https://pubmed.ncbi.nlm.nih.gov/26243431/). Health Technol Assess. 2015 Aug;19(62):1-62.
5. Gupta Y, Mahara D, Lamichhane A. McMurray’s Test and Joint Line Tenderness for Medial Meniscus Tear: Are They Accurate? (https://pubmed.ncbi.nlm.nih.gov/28450773/) Ethiop J Health Sci. 2016 Nov;26(6):567-572.
6. StatPearls. Anatomy, bony pelvis and lower limb, knee lateral meniscus. https://www.statpearls.com/ArticleLibrary/viewarticle/24101#ref_25572055.

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