0:04 This is Brent of the Brookbush Institute and in this video we're going to do the 0:07 McMurray's test for medial and lateral meniscus tears. I'm going to have my friend 0:11 Yvette come out she's going to help me demonstrate. I'll explain some of the 0:15 variations that have been seen around this test which I'm sure get a little 0:18 confusing when you're going from text to text, and then we'll talk a little bit 0:21 about specificity and sensitivity and why I chose this particular test to use 0:26 as my meniscus test. Alright so let's go through the technique real quick, or at 0:33 least the technique that is most conventional, the one that is used most 0:38 often. You're going to grab the knee and there is a little bit of detail here, 0:42 you want to get your index finger and your thumb over the medial and 0:47 lateral joint line, and the easiest way to do that is to get your 0:51 fingers close and then you can just flex and extend the knee until you 0:55 find it. Remember you're your patients have no idea what you're doing, 0:59 so don't think that you have to just be like BAM and get right though right to 1:03 the joint line the first time every time, like I still have to go through 1:06 sometimes and people have you know Anatomy that's a little different and it 1:10 takes me a second to find their joint line, that's fine. So now I have my 1:13 index finger and my thumb over the joint line, the next thing we're going to do is 1:17 grab a hunk of calcaneus and wrap our hands around the ankle, and what 1:23 we're doing that for is so that we can have control over tibial rotation here. 1:27 I can medially rotate, I can laterally rotate her tibia. Now we're 1:31 going to push all the way into maximal knee flexion, after we get past this step 1:37 we have little derivations depending on whether we're trying to test the medial 1:41 meniscus or the lateral meniscus. If I'm trying to test the medial meniscus I am 1:48 going to maximally externally rotate her tibia. Now a positive on this test is the 1:56 feeling or hearing a clunking or click. I.e. we've lost some stability from the 2:03 tear, or maybe we're catching the tear in the meniscus as we go from this position 2:11 to this position. So basically we wind Yvette's leg up 2:18 and then we're going to see if we feel or hear a click unwinding the leg, does that 2:23 make sense? This is one of those tests when I got taught it in school it 2:27 always confused me, but it's really not that complicated you just wind 2:31 everything up and then I'm really trying to feel with myindex finger here on 2:36 her medial meniscus, do I feel a clunk as I get her back towards full extension, 2:44 and in this case the answer is no. I could then follow up and be like does that 2:48 replicate any of your symptoms, and of course if she says no we got a little 2:52 bit more confirmation that that's a negative McMurray's test. Now we still 2:56 have the lateral meniscus to go and what we're going to do with the lateral meniscus 2:59 is almost the same thing, except now we're going to go maximal internal rotation 3:04 and I'm feeling with my thumb on the lateral side of the knee, and again I'm 3:10 going to see if there's a clunk or click as I unwind everything. So it's almost like 3:17 I'm going to put the leg back down, and I don't feel anything. Alright so she 3:22 feels good, doesn't seem like there's a problem with the meniscus. Now let's talk 3:28 a little bit about specificity sensitivity, so we know what weights we 3:32 should place on this test within our diagnosis or our assessment of our 3:38 patient and client. I have to tell you meniscus assessments even when 3:45 considered amongst a subjective evaluation and maybe some initial x-rays 3:53 or something like that, we're pretty bad at knowing whether a meniscus is torn or 3:58 not. Until somebody gets in there surgically, like we're not real 4:03 great at identifying stuff so it's important that anytime you get a 4:07 positive meniscus diagnosis you treat it with some skepticism. Do not run all the 4:13 way to the far whatever and say you need surgery because you have a meniscus tear, 4:19 chances are if somebody has a meniscus tear it's probably good to at least try 4:24 a few sessions of therapy and see if you can get a result, because obviously we 4:28 know there are risks with surgery and there's 4:30 no guarantee that somebody's going to get better with surgery either. We might as 4:33 well start conservative and we always can put surgery as an option later. 4:39 Now this is one of the most studied meniscus special tests which is why I 4:46 have chosen this test to include within our special test courses, right as we 4:51 have this test that for the most part demonstrates good specificity but fairly 4:56 low sensitivity, and I'm going to pair this test with another test called the 5:02 Thessaly's test which we'll do in a separate video. So if I do find a click 5:06 or pop on this video I am going to give it some weight in the sense that I may have 5:10 a positive. If I get nothing from this test, as in I get a negative, I know that 5:16 I can't weigh that very heavily because once again this is specific not 5:19 sensitive. If I get a negative there is still a chance that there is a meniscal 5:23 tear, you follow that? So a yes means something on this test, a no means very 5:31 little on this test. In general you should treat all diagnoses of meniscus 5:36 tears with some level of skepticism and probably move forward with some physical 5:41 therapy or chiropractic athletic training. You know whatever field of 5:46 human movement science you're in you should probably give therapy a try. So 5:51 let me review the technique one more time here, you're going to grab some knee, 5:56 thumb on lateral joint line, index finger on medial joint line, grab some of 6:04 calcaneus, make sure you found the joint line. Alright so remember your 6:10 your patients don't know, my students out there your patients don't know if 6:14 wiggling them and moving them back and forth as part of the test, 6:17 so do whatever you need to define the joint line. Once you've found it you're 6:20 comfortable you got a good grip, you're going to wind them up, if we're going for 6:25 medial meniscus it's external rotation so pair that in your mind, 6:29 medial external rotation, right medial external rotation I'm going to palpate. I 6:36 know a positive is a thud or click, either heard or palpated as 6:42 unwind and let the knee back down. If I want to go lateral meniscus, maximal 6:49 internal rotation and flexion, I'm now feeling with my thumb on the lateral 6:53 aspect of the knee, and I'm feeling for a pop or click as I come back down. If 6:59 you have any questions whatsoever leave them in the comments box below, I'll be 7:03 happy to try to answer them for you.
