Focused examination of the medial and lateral menisci including McMurray test, Thessaly test, Apley's, and differentiation of meniscal from ligamentous pathology.
Meniscal examination relies on joint line tenderness and provocative tests that trap and stress the meniscus. Examiners expect you to perform McMurray's test correctly, understand its limitations, and recognize that clinical examination has moderate sensitivity. Joint line tenderness is the most sensitive but least specific finding.
High-Yield Exam Summary
Meniscal Anatomy:
Functions:
Tear Patterns:
Acute Tear (Young Patient):
Degenerative Tear (Older Patient):
Locking vs Pseudolocking:
Localize meniscal pathology
Point tenderness at joint line (medial or lateral)
Meniscal pathology (most sensitive but least specific sign)
Ability to detect true positives
Ability to exclude false positives
Meniscal tear
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Palpable or audible click/pop at joint line, with pain
Meniscal tear (posterior horn)
Ability to detect true positives
Ability to exclude false positives
McMurray Test Tips:
Meniscal tear (functional, weight-bearing)
Joint line pain or mechanical catching
Meniscal tear
Ability to detect true positives
Ability to exclude false positives
Differentiate meniscal from ligamentous pathology
Pain on COMPRESSION = meniscal; Pain on DISTRACTION = ligamentous
Compression stresses meniscus, distraction stresses ligaments
Ability to detect true positives
Ability to exclude false positives
Block to full extension
Rubbery block to full extension (does not fully extend)
Mechanical block (bucket-handle meniscal tear, loose body)
Ability to detect true positives
Ability to exclude false positives
Meniscal tear (weight-bearing deep squat)
Pain or click at affected joint line during squat
Meniscal tear
Ability to detect true positives
Ability to exclude false positives
Meniscal tear
Pain at joint line with rotation
Meniscal tear
Ability to detect true positives
Ability to exclude false positives
Clinical Features:
Examination:
Clinical Features:
Examination:
| condition | location | mechanical | test |
|---|---|---|---|
| Medial Meniscus Tear | Medial joint line | Yes (locking/catching) | McMurray (ER + valgus) |
| Lateral Meniscus Tear | Lateral joint line | Yes | McMurray (IR + varus) |
| MCL Sprain | Medial, above joint line | No | Valgus stress + |
| Pes Anserine Bursitis | Below medial joint line | No | Point tenderness at pes |
| OA | Joint line + diffuse | Variable | Crepitus, X-ray changes |
"45-year-old man with medial knee pain after twisting injury while gardening 2 weeks ago. Reports occasional 'catching' sensation."
| feature | medial | lateral |
|---|---|---|
| McMurray Rotation | External rotation | Internal rotation |
| McMurray Stress | Valgus | Varus |
| Joint Line | Medial | Lateral |
| Frequency | More common (less mobile) | Less common (more mobile) |
| ACL Association | Less common | More common (lateral meniscal tear with ACL injury) |
High-Yield Exam Summary