What is the McMurray Test?
The McMurray test is a physical examination technique used to identify tears of the medial and lateral menisci of the knee. It is one of the most commonly performed orthopedic tests in physical therapy and orthopedic medicine, and it is a foundational clinical skill taught in every DPT and medical program. When positive, the test produces a palpable or audible click — or reproduces joint line pain — as the examiner moves the knee through a controlled arc of rotation and extension.
Quick Reference
| Also known as | McMurray’s test, McMurray circumduction test |
| Structure tested | Medial and lateral menisci |
| Patient position | Supine, knee fully flexed |
| Positive sign | Palpable/audible click or joint line pain during arc of motion |
| Sensitivity | ~53–58% (medial); ~45–50% (lateral) |
| Specificity | ~77–83% (medial); ~80–85% (lateral) |
What the McMurray Test Assesses
The McMurray test is designed to stress the menisci of the knee by trapping and compressing meniscal tissue between the tibial plateau and femoral condyle. By combining tibial rotation with valgus or varus force during passive knee extension, the examiner creates a shearing load across the meniscus. A tear disrupts this movement and typically produces a mechanical click or joint line pain.
The medial and lateral menisci are assessed using opposite rotational directions:
- External tibial rotation + valgus stress — loads the medial meniscus
- Internal tibial rotation + varus stress — loads the lateral meniscus
Anatomy: The Knee Menisci
The knee contains two C-shaped fibrocartilaginous structures — the medial meniscus and the lateral meniscus — seated between the femoral condyles and tibial plateau. Their primary functions are load distribution, shock absorption, and joint stability.
The medial meniscus is more firmly anchored to the joint capsule and the medial collateral ligament, making it less mobile and more susceptible to injury. The lateral meniscus is smaller and more mobile, with fewer peripheral attachments. Meniscal tears can result from acute trauma — commonly a twisting mechanism during sport — or from degenerative changes in middle-aged and older adults.
Tears are classified by location (anterior horn, body, posterior horn) and pattern (radial, horizontal, bucket-handle, complex). The McMurray test is most sensitive for posterior horn tears, which are the most common location for both acute and degenerative meniscal injury.
How to Perform the McMurray Test
Starting Position
The patient lies supine on the examination table with the knee fully flexed — ideally heel to buttock, or as far as range and pain allow. The examiner stands beside the involved limb.
Hand Placement
One hand cups the heel to control tibial rotation throughout the movement. The other hand grasps the knee with the thumb over the lateral joint line and fingers along the medial joint line. This hand applies the valgus or varus stress and simultaneously palpates for a click or clunk as the knee moves.
Medial Meniscus Procedure
- Begin with the knee in full flexion.
- Externally rotate the tibia (foot turns outward).
- Apply a valgus force at the knee (stress the medial compartment).
- Slowly and passively extend the knee while maintaining external rotation and valgus stress.
- Palpate the medial joint line for a click, clunk, or reproduction of pain.
Lateral Meniscus Procedure
- Begin with the knee in full flexion.
- Internally rotate the tibia (foot turns inward).
- Apply a varus force at the knee (stress the lateral compartment).
- Slowly and passively extend the knee while maintaining internal rotation and varus stress.
- Palpate the lateral joint line for a click, clunk, or reproduction of pain.
Arc of Movement and Tear Location
The test is performed through the full available range from flexion toward extension. The arc of motion at which a click or pain occurs gives information about tear location:
- Click near full flexion — suggests a posterior horn tear
- Click in mid-range — suggests involvement of the body of the meniscus
- Click near extension — suggests an anterior horn tear (less common)
Video Demonstration of McMurray’s Test
video source: reesmd101
Positive Sign and Interpretation
The McMurray test is considered positive when the examiner detects a palpable or audible click, clunk, or pop during the arc of movement — or when the patient reports joint line pain clearly reproduced by the maneuver.
Not all findings carry equal diagnostic weight:
- Palpable or audible click with joint line pain — strongest positive finding; most suggestive of meniscal pathology
- Click without pain — lower diagnostic value; can occur in asymptomatic knees and should be interpreted cautiously
- Joint line pain without a click — common with smaller or incomplete tears; clinically significant when it clearly reproduces the patient’s familiar symptoms
The side of the finding matters: a click or pain on the medial side during external rotation implicates the medial meniscus; a finding on the lateral side during internal rotation implicates the lateral meniscus.
Sensitivity and Specificity
The McMurray test has been extensively studied in published meta-analyses and systematic reviews, with results that vary by study population, examiner experience, and reference standard (clinical diagnosis, MRI, or arthroscopy).
| Metric | Medial Meniscus | Lateral Meniscus |
|---|---|---|
| Sensitivity | ~53–58% | ~45–50% |
| Specificity | ~77–83% | ~80–85% |
| Positive Likelihood Ratio | ~2.5 | ~2.0 |
| Negative Likelihood Ratio | ~0.5 | ~0.6 |
Values are approximate ranges from published meta-analyses. Reference standards vary across studies.
In practice, these numbers mean the McMurray test is better at ruling in than ruling out a meniscal tear. A positive test meaningfully raises clinical suspicion; a negative test does not reliably exclude pathology. This is why the McMurray test is almost always used alongside joint line palpation, the Thessaly test, and imaging when the diagnosis remains uncertain.
Clinical Considerations
Limitations
- The test requires full or near-full knee flexion. Patients with significant swelling, stiffness, or acute pain may not tolerate the starting position — in these cases, the test result is unreliable or impossible to perform.
- False positives can occur with other intra-articular pathology, including plica syndrome, loose bodies, and patellofemoral pain.
- Examiner technique significantly affects test accuracy. Consistent hand placement, controlled rotation, and appropriate force are essential for reliable results.
- The test is generally more accurate in the hands of experienced clinicians who can distinguish a pathological click from a benign joint noise.
When to Use It
The McMurray test is appropriate in the evaluation of patients presenting with:
- Medial or lateral joint line pain
- History of a twisting injury or mechanism consistent with meniscal involvement
- Knee swelling, locking, catching, or giving way
- Suspected degenerative meniscal tear in middle-aged or older adults
It is typically performed as part of a complete knee examination that includes ligamentous stability testing (Lachman, anterior drawer, valgus/varus stress tests), patellofemoral assessment, and functional observation.
History and Eponym
The McMurray test is named after Thomas Porter McMurray (1887–1949), a British orthopedic surgeon at the Royal Infirmary in Liverpool. McMurray described the test in his 1942 paper The Semilunar Cartilages, published in the British Journal of Surgery. His original description emphasized the audible or palpable click as the hallmark positive sign, produced by a torn meniscus being displaced and snapping back during the rotational maneuver. The test has since been refined and validated extensively, though the core mechanics remain true to McMurray’s original description.
Related Knee Tests
- Apley’s Test — performed prone with compression and distraction; differentiates meniscal from ligamentous injury
- Thessaly Test — performed weight-bearing at 20° knee flexion; some evidence suggests higher sensitivity than McMurray for meniscal tears
- Anterior Drawer Test — assesses ACL integrity; commonly performed in the same examination session
- Lachman Test — primary ACL assessment test; higher sensitivity than the anterior drawer test
- Valgus and Varus Stress Tests — assess the medial and lateral collateral ligaments
Frequently Asked Questions
What does a positive McMurray test mean?
A positive McMurray test — defined as a palpable or audible click, or joint line pain reproduced during the maneuver — suggests a meniscal tear. A finding during external rotation implicates the medial meniscus; internal rotation implicates the lateral meniscus. A positive result increases clinical suspicion but should be confirmed with MRI or arthroscopy before surgical decisions are made.
How accurate is the McMurray test?
The McMurray test has moderate sensitivity (approximately 53–58% for the medial meniscus) and better specificity (approximately 77–83%). It is more useful for ruling in a tear than for ruling one out. Diagnostic accuracy improves when the McMurray test is combined with joint line palpation and the Thessaly test.
Should you test both knees?
Yes, and it is often useful to test the uninvolved side first. This gives the examiner a baseline sense of what is normal for that patient and helps the patient understand what the maneuver feels like before it is applied to the symptomatic knee. Bilateral comparison can also reveal subtle differences in joint line pain or mechanical response.
What is the difference between the McMurray test and Apley’s test?
Both tests assess for meniscal tears, but the mechanics and positions differ. The McMurray test is performed supine, moving the knee through a passive rotational arc — the click is the primary positive sign. Apley’s test is performed prone with the knee at 90°, using compression and distraction to differentiate meniscal injury (pain with compression) from ligamentous injury (pain with distraction). The two tests complement each other and are often performed together in a comprehensive knee examination.
Does a click always mean a meniscal tear?
No. A click without joint line pain has low diagnostic significance and can occur in structurally normal knees. The strongest positive finding is a click or clunk that reproduces the patient’s familiar joint line pain. Asymptomatic clicking should be noted but interpreted with caution, and the overall clinical picture — mechanism of injury, symptom pattern, joint line tenderness — should always inform the working diagnosis.
>> Return to the list of Common Tests in Orthopaedic Examination of the Knee
Pingback: Dualism, Materialism, and Athletic Trainers – kyleornelas