import { HighYieldBox, ExamCheatSheet, Tabs, Tab, ComparisonTable, VivaScenario, ContentSection, SpecialTestCard , MedicalImage} from '@/components/content' # Knee Meniscus Examination 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. ## Quick Reference One-Pager ## Anatomy and Function **Meniscal Anatomy:** - C-shaped fibrocartilage structures - Medial: Larger, more C-shaped, firmly attached (less mobile) - Lateral: Smaller, more circular, loosely attached (more mobile) - Blood supply: Outer 1/3 vascular (red zone), inner 2/3 avascular (white zone) **Functions:** - Load transmission (50-70% of load) - Shock absorption - Joint stability (secondary stabilizer) - Lubrication and nutrition **Tear Patterns:** - Vertical longitudinal (bucket-handle) - Horizontal cleavage - Radial - Complex/degenerative - Root tears ## Clinical Assessment **Acute Tear (Young Patient):** - Twisting injury, often with knee flexed - May have popping sensation - Delayed swelling (hours, not immediate like ACL) - Mechanical symptoms (locking, catching) **Degenerative Tear (Older Patient):** - Minimal or no trauma - Insidious onset - Aching pain, worse with activity - May have night pain - Associated with OA **Locking vs Pseudolocking:** - **True locking**: Knee stuck in flexion, cannot fully extend (bucket-handle tear) - **Pseudolocking**: Pain prevents movement but no mechanical block ## Physical Examination ### Joint Line Tenderness ### Provocative Tests **McMurray Test Tips:** - The click must be at the JOINT LINE (not patellofemoral) - A painful click is more significant than painless click - Tests posterior horn primarily (most common tear location) - Negative test does NOT exclude tear ### Additional Signs ## Specific Patterns **Clinical Features:** - True locking (cannot fully extend) - Loss of last 10-30° extension - May unlock suddenly - Audible clunk on reduction **Examination:** - Fixed flexion deformity - Bounce home test positive - Springy block to terminal extension - May palpate displaced meniscus **Clinical Features:** - Sudden pop, often without contact - Significant pain and effusion - Loss of meniscal function → accelerated OA **Examination:** - Posterior joint line tenderness - May be indistinguishable from regular tear clinically - MRI essential for diagnosis ## Differential Diagnosis ## Summary Presentation ## Medial vs Lateral Meniscus Testing ## Examiner Tips