Knee Orthopaedic Test: McMurrays Test

McMurray’s Test assesses meniscal symptom reproduction during knee flexion, extension and tibial rotation. A positive test may include familiar joint-line pain, clicking, catching or a palpable clunk. Diagnostic accuracy varies, so McMurray’s Test should be interpreted with history, joint-line tenderness, swelling, mechanical symptoms and other meniscal tests.

Introduction

A client may report knee pain with twisting, squatting, loaded flexion, clicking or intermittent catching. McMurray’s Test can help assess whether tibiofemoral rotation and movement through knee flexion reproduce symptoms consistent with meniscal involvement.

Recent meniscal evidence continues to show that individual tests vary in diagnostic performance. A composite clinical approach using multiple positive findings may be more useful than relying on one test.  

Quick Summary

Test name: McMurray’s Test
Purpose: Assess meniscal symptom reproduction during knee movement and rotation
Body region: Knee
Commonly associated presentation: Suspected meniscal tear, joint-line pain, mechanical symptoms
Positive finding: Familiar joint-line pain, clicking, catching, locking or palpable clunk during the manoeuvre
Negative finding: No familiar joint-line pain or mechanical symptoms
Best used with: Apley’s Test, Thessaly Test, Ege’s Test, joint-line tenderness, swelling assessment and imaging when indicated
Key limitation: Diagnostic accuracy is variable and often modest when used alone

What Is McMurray’s Test?

McMurray’s Test is a knee orthopaedic test where the examiner moves the knee through flexion and extension while rotating the tibia. The test is designed to reproduce meniscal symptoms.

Different combinations of tibial rotation and valgus or varus positioning may bias the medial or lateral meniscus, but clinical interpretation should remain cautious.

Why It Is Used

The test is used when meniscal injury is suspected based on joint-line pain, twisting injury, clicking, catching, swelling or symptoms during loaded knee flexion.

What It Assesses

The test assesses symptom response to tibiofemoral motion and rotation.

It does not directly visualise the meniscus, identify tear type, confirm mechanical instability or determine whether imaging or surgery is needed on its own.

Who It Is Useful For

McMurray’s Test may be useful for clients with suspected meniscal involvement, joint-line pain, intermittent catching, clicking, swelling after twisting or pain during squatting.

It may not be suitable when the knee is acutely locked, highly irritable, severely swollen or unable to tolerate passive movement.

When to Use This Test

Use the test when the history and symptoms suggest possible meniscal involvement and the client can tolerate passive knee movement.

When Not to Use or When to Be Cautious

Use caution with acute locked knee, severe swelling, suspected fracture, post-operative restrictions, significant instability or high pain irritability.

Equipment Required

Treatment table
Pain scale
Measurz for recording
Optional comparison notes
Optional referral or imaging notes

Step-by-Step Protocol / Practice

Setup

Position the client supine.

Client position

The tested knee and hip are flexed. The client should remain relaxed.

Examiner position

Stand beside the tested limb.

Hand placement

One hand holds the foot or ankle to control tibial rotation. The other hand palpates or supports around the knee joint line.

Stabilisation

Control hip and knee movement while avoiding excessive force.

Movement or force direction

Move the knee from flexion toward extension while applying tibial rotation. Adjust rotation and side-bias according to the meniscus being assessed.

Instructions

Ask the client to report joint-line pain, clicking, catching, locking or familiar symptoms.

Positive finding

A positive finding may include familiar joint-line pain, clicking, catching, locking or a palpable clunk.

Negative finding

A negative finding is no familiar joint-line pain or mechanical symptoms during the test.

Stopping criteria

Stop if pain escalates, the knee locks, guarding prevents movement or the test is not tolerated.

Safety notes

Use controlled movement. Do not force rotation or extension.

Positive and Negative Test Interpretation

A positive McMurray’s Test may increase suspicion of meniscal involvement when familiar joint-line pain or mechanical symptoms are reproduced and match the history.

A negative test does not exclude meniscal injury because diagnostic accuracy is variable. Interpretation is stronger when combined with joint-line tenderness, Apley’s, Thessaly, Ege’s, swelling history and functional symptoms.

Sensitivity, Specificity and Diagnostic Accuracy

A 2020 study comparing clinical examination, MRI and arthroscopy reported that clinical examination by an experienced examiner can be useful, but individual meniscal tests vary in performance.  

A 2021 clinical study reported that meniscal clinical tests are inconsistent and that a composite of at least two positive tests can improve diagnostic value, sometimes approaching MRI-level diagnostic performance in specific settings.  

Older systematic reviews found that special tests for meniscal tears, including McMurray’s Test, have variable diagnostic accuracy and should not be used alone.  

Reliability and Validity

Reliability depends on examiner technique, rotation force, knee flexion angle, symptom criteria and whether a palpable or audible click is required for a positive result.

Validity is strongest when McMurray’s Test reproduces familiar joint-line mechanical symptoms and is interpreted with other meniscal findings.

Common Errors and Limitations

Common errors include applying excessive rotation, interpreting general knee pain as positive, failing to record pain location, forcing the knee into painful range, ignoring swelling and relying on the test alone.

Limitations include variable accuracy, symptom overlap, low sensitivity in some studies and difficulty distinguishing pain from mechanical signs.

Practical Applications

Use McMurray’s Test as one part of a meniscal assessment. It can help document symptom reproduction and guide whether further testing, load modification or imaging may be appropriate.

How to Record This in Measurz

Record test name, side tested, result as positive, negative, unclear or unable to test, pain score, symptom location, click, catch, lock, clunk, rotation direction, knee angle range, confidence in result, stopping reason and related findings.

Related Tests / Internal Links

Apley’s Test
Thessaly Test
Ege’s Test
Steinman Test
Joint-Line Tenderness
Sweep Test
Knee ROM Tests

FAQs

What does McMurray’s Test assess?

It assesses meniscal symptom reproduction during knee movement and tibial rotation.

What is a positive McMurray’s Test?

A positive test may include familiar joint-line pain, catching, clicking, locking or a palpable clunk.

Does McMurray’s Test diagnose a meniscal tear?

No. It supports clinical reasoning but does not confirm a tear on its own.

Is a click always positive?

Only if it is clinically relevant and matches the client’s symptoms. Pain location and familiarity matter.

What should be recorded?

Record pain location, mechanical symptoms, rotation direction, knee range and confidence in the result.

Key Takeaways

McMurray’s Test assesses meniscal symptom reproduction.
A positive test may support suspicion of meniscal involvement.
A negative test does not rule out meniscal injury.
Accuracy is variable when used alone.
Record symptoms, mechanical findings and test details in Measurz.

References

Amin, N. H., et al. (2020). Comparison of accuracy in expert clinical examination versus magnetic resonance imaging and arthroscopy in diagnosis of meniscal tears. Archives of Bone and Joint Surgery, 8(2), 152–156.

Ercin, E., et al. (2021). Diagnostic value of clinical tests and MRI for meniscal injury in patients with anterior cruciate ligament injury. Journal of Clinical Orthopaedics and Trauma, 18, 35–40.

Smith, B. E., Thacker, D., Crewesmith, A., & Hall, M. (2015). Special tests for assessing meniscal tears within the knee: A systematic review and meta-analysis. Evidence-Based Medicine, 20(3), 88–97.