Specific examination- the menisci
This is best performed with the knee flexed at 90 degrees. Both hands may be needed to palpate the specific trigger points around the knee while supporting the leg with the other hand. It is useful to ask the patient to indicate where the pain is felt, as meniscal problems tend to be point specific where as degenerative problems are more vague in distribution.
- Meniscal tenderness: Palpation for tender trigger points involves targeted pressure over specific areas. Meniscal tenderness is particularly deep and therefore takes a fair amount of force, usually pushing the pulp of two fingers or sometimes the thumb to elicit the pain
- Medial meniscal tenderness is classically on the postero medial part of the joint line .
- Lateral meniscal tear tenderness is on the mid lateral aspect
- Swelling: An associated fullness or obvious swelling may be sensed due to either an associated cyst (usually lateral) or sometimes the flap of a meniscus (typically medial). Lateral meniscal cysts stay at the level of the joint line and tend to be very hard – enough to be mistaken for bony lumps. Medial cysts tend to be just below the joint line
- Pain on movement
- Meniscal pain on full flexion. Pressure on the meniscus is increased in full flexion and may be resisted by the patient
- McMurrays test. In this test rotation in forced flexion with compression over the medial joint line is positive if it elicits a clunk from a torn meniscus as the test was originally described. It is less reliable if used with simple detection of pain.
- Squat or duck walking. This mimics McMurrays manoeuvre, compressing the menisci in deep flexion. The patient is asked to squat and walk or waddle a few steps, eliciting their characteristic pain. This can be a very useful confirmatory test.
- Apleys grind test. This is less commonly used but the patient is positioned prone, the knee flexed to 900 and the tibia ground into the femur looking for pain from a meniscal tear.