Clinical Examination for Diagnosing Meniscal Tears

Meniscal tears are common, and there are a number of different examination techniques for determining their presence. For the McMurray test, the patient is positioned supine; the proximal hand holds the knee and palpates the joint line while the distal hand holds the sole of the foot. From a position of maximal flexion, the knee is extended with internal rotation of the tibia and varus stress for the detection of lateral meniscal tears. The knee is then returned to maximal flexion and extended with external rotation of the tibia and a valgus stress for detection of medial meniscal tears. Positive findings are pain, snapping, audible clicking, or locking, indicating a compromised medial or lateral meniscus. Joint line tenderness can be used to screen for sensitivity related to meniscal injuries. If pain is localized to either the medial or lateral aspect of the joint, it could suggest compromised integrity of the medial or lateral meniscus. The test is usually performed with the patient relaxed in supine position and the knee flexed to 90 degrees, and asking the patient if palpation elicits tenderness. For diagnosing medial meniscal tears, the tibia is rotated internally and the medial joint line is palpated. To diagnose lateral tears, the tibia is rotated externally and the lateral joint line is palpated.