Brian R. Waterman, Brett D. Owens, in Operative Techniques: Knee Surgery (Second Edition), 2018. Read our, Medically reviewed by Stuart Hershman, MD, Medically reviewed by Jonathan Cluett, MD, Verywell Health uses cookies to provide you with a great user experience.
A displaced bucket-handle tear may block full extension. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). When testing the medial meniscus the tibia starts the manoeuvre in internal rotation. Posterior stress radiographs may be obtained in patients with PCL ruptures.
Posterior cruciate ligament injuries are most frequently the result of a blow to the front of the flexed knee. A varus stress is also applied. Alternatively, a posteromedial or posterolateral portal can be established for inspection of the posterior knee capsule. Place the tested leg back in maximal hip and knee flexion. The location of the connection between the meniscal tear and the cyst can often be identified with an arthroscopic probe, trocar, or Wissinger rod (Fig. Central tears are sometimes detected with this maneuver. What Types of Surgery Are Used to Treat Knee Injuries? La main caudale saisie la face plantaire du pied avec une prise globale au niveau du calcanéum pour assurer une prise puissante. The primary symptom from popliteomeniscal tears is lateral compartment pain with activities, especially turning and twisting with sports. On amène la jambe en rotation latérale et en abduction. Perimeniscal or popliteal cysts may spontaneously resolve upon treatment of the underlying meniscal pathology or capsular defect. Posterior Sag Test; Reverse Pivot Shift; Thessaly Test; Valgus Stress Test; Varus Stress Test; Valgus and Varus; McMurray test . Other clinical signs include pain on forced flexion, obvious meniscal displacement during joint compression and flexion and extension, lack of full extension, and a positive, Michael A. Krieves, ... Elizabeth Demers Lavelle, in, Mild effusion is usually present on physical examination, as well as tenderness at the medial or lateral joint line. Lateral meniscectomy may quickly progress to diffuse tibiofemoral degenerative changes in high-impact athletes. 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 knee is brought to full extension while maintaining rotation. J Man Manip Ther. They help absorb forces in the knee as well as improve the ‘fit’ of the joint. Increased meniscal laxity or excursion without evidence of a discrete tear may indicate a tear of the meniscal root or popliteomeniscal fascicle. 5.12). This test may produce a lateral palpable snapping sensation, representing an anterior subluxation of the posterior horn of the lateral meniscus with maximum internal rotation. A recent investigation that examined the ability of MRI to predict reparability of longitudinal full-thickness meniscus lesions reported high sensitivity and specificity rates (overall, 94% and 81%, respectively).149. Axial lower limb alignment is measured using double-limb standing hip-knee-ankle weight-bearing radiographs22 in knees that demonstrate varus or valgus alignment.
I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. A positive test is indicated by pain in association with a clunk, as the torn meniscus fragment is manipulated between the femur and tibia. Radiographs taken during the initial examination include lateral at 30 degrees of knee flexion, weight-bearing PA at 45 degrees of knee flexion, and patellofemoral axial. The squatting position places great stress on the posterior horns of both menisci and is painful if the posterior horn is torn. Outside-in pie crusting with gentle valgus stress may improve visualization and easier manipulation of the posterior horn through fractional lengthening of a tight medial collateral ligament. Il est positif quand on arrive à reproduire une douleur ou un ressaut palpable (et parfois audible) lors du mouvement d'extension de genou imprimé par l'examinateur sur un patient en décubitus. Medial meniscus and lateral meniscus of the knee ; Diagram by BruceBlaus – Own work, CC BY-SA 4.0, Link. Complete radial resection or disruption of the anterior or posterior root attachments may result in significant loss of hoop stresses functionally similar to a subtotal meniscectomy. Painful conditions of the knee, in Pain Management Vol 1., 2007. While many people assume that an MRI (magnetic resonance imaging) scan would be the first step in diagnosing this type of injury, the McMurray test is often enough to provide a definitive diagnosis. When testing the lateral meniscus the tibia starts the manoeuvre in external rotation. These variations constitute different tests with different statistical performance and should not be confused with the original. The knee is fully bent and pulled toward outwards in a "bow-legged" position. To test for meniscal Injury.
A block to passive extension may occur if there is a large, displaced, “bucket-handle” tear.
The McMurray test is performed in a doctor's office with the patient undressed to his or her underwear. The snapping is produced with external rotation as the meniscus returns to … A thorough history includes assessment of the injury mechanism, initial and residual symptoms, and functional limitations. Physical Therapy Can Help, Problems Can Develop From Over-Supination of the Feet or Forearms, Kneecap (Patella) Injuries: Types, Causes, Treatment, Your Meniscus May Be Able to Heal Itself Without Surgery, A Meniscal Cyst Is Caused By Having Joint Fluid in the Knee, 6 Types of Meniscus Tears and How Their Treatment Differs, Physical Therapy for the Unhappy Triad in Your Knee, What You Should Know About Hamstring Muscle Strains. 5.14). Failure to fully débride a meniscal tear associated with a meniscal cyst may lead to recurrence of the cyst. A positive test produces a pop or click. The McMurray test for torn meniscus can provide the clinician with useful information as to the whether a torn medial or lateral meniscus is responsible for the patient's knee pain. The McMurray Test is a commonly used test in orthopedic examinations to test for damage/tears to the meniscus. Test Position: Supine. Description. Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery. Other clinical signs include pain on forced flexion, obvious meniscal displacement during joint compression and flexion and extension, lack of full extension, and a positive McMurray test result.127,140 All ligament stability tests are performed and compared with the opposite knee joint. The test is considered positive for a meniscus tear if the patient experiences medial or lateral joint line discomfort.
The Apley compression test, used to assess meniscal integrity, is performed with the patient prone and the examiner’s knee over the patient’s posterior thigh. Nicholas A Piantanida MD, Nicole T Yedlinsky MD, in The Sports Medicine Resource Manual, 2008, McMurray's test is performed with the patient supine and relaxed. The examiner grasps the patient's heel with one hand and the joint line of the knee with the other hand. We use cookies to help provide and enhance our service and tailor content and ads. Inadequate visualization or manipulation of the meniscal tear may result in untreated pathology and persistent pain. 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). The knee actually has two ‘menisci’; the lateral meniscus and the medial meniscus. McMurray Test. If the cyst aperture cannot be identified, an 18-gauge spinal needle may be inserted from outside in through the cyst to help decompress or trephinate the cyst cavity. Reliability of two clinical meniscal tests and magnetic resonance imaging. The knee to be tested should be fully flexed. He specializes in spinal deformity and complex spinal reconstruction. Le test de McMurray est une manœuvre utilisée pour évaluer une atteinte organique au niveau des ménisques du genou[1]. Joint line tenderness, especially along the respective posterior joint line, is commonly present. Hing W, White S, Reid D, Marshall R. Validity of the McMurray's Test and Modified Versions of the Test: A Systematic Literature Review. The doctor holds the knee in one hand and the sole of the foot in the other. Philippe Gadet précise aussi que la fiabilité du test augmente lorsque celui-ci est associé au test de sensibilité par palpation des interlignes articulaires[9]. The McMurray test is named after Thomas Porter McMurray,[2] a British orthopedic surgeon from the late nineteenth and early twentieth century who was the first to describe this test.
Symptoms are usually more prevalent with squatting or twisting of the knee. Loose meniscal fragments are removed with a large-diameter shaver while milking the posterior aspect of the knee to express residual debris. Internal rotation is applied to the tibia while the knee is flexed to 40 degrees under a valgus stress (pushing the outside of the knee medially). 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. 2008. This alone may release the locked knee. One of the more common knee injuries involved the tearing of internal cartilage surrounding the joint. 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. This critical function in the range of 0 to 30 degrees is important for movements such as side-stepping and pivoting. It can be properly performed only if the patient has a reasonably full and relatively pain-free range of motion. A thorough history including assessment of prior operative records and current symptoms and functional limitations is taken. This final role is the main clinical function of the ACL. The doctor will then start rotating the foot externally while extending the knee. Fig. The McMurray test is especially useful for detecting tears in the posterior (back) aspect of the knee.
The flexion, Examination maneuvers.
5.10). The patient complains of loss of smooth motion, giving out of the knee, or less commonly, locking. Axial lower limb alignment is measured using full standing hip-knee-ankle weight-bearing radiographs56 in knees that demonstrate varus or valgus alignment. 5.9A–E). En maintenant cette mise en tension, on amène le genou vers l'extension. Sign up and learn how to better take care of your body. Reliability of two clinical meniscal tests and magnetic resonance imaging. In its stabilizing role it has four functions: (1) restrains anterior translation of the tibia; (2) prevents hyperextension of the knee; (3) acts as a secondary stabilizer to valgus stress, reinforcing the medial collateral ligament; (4) controls rotation of the tibia on the femur in femoral extension of 0 to 30 degrees. Any “popping” or pain along the joint … 460.). The patient may also have a sense of locking or catching in the knee. As pain subsides, straight leg raises should be done to strengthen the quadriceps. La main du praticien est posée sur l'interligne fémoro-tibiale.