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