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Written by Garotta Lorenzo
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Broadly speaking, the menisci should be examined with the knee in flexion. There will be tenderness (i.e. the patient will respond to palpation with pain). There are various ways in which the sensitivity of the tests can be enhanced. However, all the tests for meniscal lesions rely on the same principle: Stressing an injured medial or lateral meniscus will cause pain.
Tenderness to palpation is elicited with the knee flexed 90° (image #1) and the patient's foot resting on the table. The examiner's index finger probes the meniscus along the joint line. The most frequently encountered sites of tenderness are over or behind the medial collateral ligament, at the medial meniscal tender point. Less often the tender point will be anterior, in which case the phenomenon may be part of a patellar disorder, a bucket-handle tear of the medial meniscus, or a lesion of the anterior horn of the lateral meniscus. The lateral meniscal tender point may be anywhere along the joint line.
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Image #1
Menisci : tenderness during palpation
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| Examining for a fixed flexion deformity: The patient is placed in the supine position and made to relax. The examiner grasps both the patient's heels and supports them at a height of 10 cm above the examination couch. This is the best position for screening for a flexion deformity, which is a major feature of knee pathology. The method is both sensitive and straightforward and is ideal for identifying a meniscal tear or other knee pathology. In addition, since the patient's feet are braced against the examiner's abdomen, the examiner can try to reduce the flexion deformity by pressing down on the patient's knees. The test shows that there is a mechanical obstruction, which prohibits the complete extension of the knee. The patient is only able to walk on the "point of the feet". This can be a bucket-handle meniscus tear, or a bulky luxated strip (a foreign body, the stub of the anterior cruciate ligament tear …). |
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| Mac Murray test : forced flexion and external rotation combined with compression of the medial joint line will elicit pain in the medial meniscus. The hand pressed over the joint line will feel a click. The test may be reversed, to examine the lateral meniscus. |
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| Rarely used in daily practice the "Grinding test" of G. Appley, is performed in a prone position with the knee flexed. Compression in external rotation and internal rotation may be painful, showing that the medial or lateral meniscus are torn. The test is always checked by performing rotation without compression. This manoeuvre should not cause discomfort, unless the collateral ligaments are affected. |
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Last Updated on Wednesday, 15 December 2010 21:29 |
Knee 
