The knee joint is one of the largest human joints and is subject to great stress. Parts of the knee joint that serve to cushion and improve mobility are the menisci. Every person has an inner meniscus and an outer meniscus.
These menisci can be damaged, especially in athletes or people who put a lot of strain on their knees at work (e.g. tilers). A meniscus test plays an important role in diagnostics, since it can quickly confirm the suspicion of meniscus damage without the use of diagnostic equipment. A meniscus test is performed manually by the treating physician by provoking pain through certain movements. Known meniscus tests are Steinmann or McMurray as well as Payr, Apley or the meniscus test according to Böhler.
Causes
Causes of meniscal damage that require a meniscus test are mainly caused by high sports strain. These include violent external forces or chronic stresses that exceed a healthy level. Soccer players, skiers, but also runners have an increased risk of damage.
In addition, people who work a lot while standing or kneeling are also more frequently affected. Another risk factor is age, so that basically everyone can suffer meniscus damage. An acute meniscus tear with immediately occurring symptoms is generally distinguished from chronic degenerative damage with insidious development.
Symptoms
The main symptom of a damaged meniscus is pain. These often occur in a characteristic manner and thus form the background of the meniscus test. Depending on the affected meniscus, the pain is mainly felt on the inner or outer side of the knee and is motion-dependent, i.e. the pain worsens when the knee is rotated or bent. In some cases, they also radiate from the knee further into the upper or lower leg. In addition, there is usually a restriction of movement due to the pain.
Diagnosis with meniscus test
The diagnosis of a meniscus lesion consists of several parts. In addition to the apparatus and imaging methods, a meniscus test is performed at the beginning of each examination. A meniscus test such as the test according to Steinmann, Payr, McMurray, Apley or Böhler is quickly performed, gives important information about the extent and localization and can be used by many examiners.
As a background to the meniscus test, the knee joint is moved in a certain way in order to stretch or irritate the menisci and thus cause pain in case of damage. If a meniscus test is positive, an MRI of the knee joint usually follows to confirm the suspected diagnosis. There are various tests that are named after their initial descriptor and are easy to learn.
- Steinmann: The meniscus test according to Steinmann is further divided into Steinmann I, a very meaningful meniscus test, and Steinmann II, which is rather secondary. Steinmann I: In the meniscus test according to Steinmann I, the patient lies flat on his back and positions the affected leg so that the knee joint is flexed 90°. The examiner grasps the hollow of the knee with one hand and palpates the joint space, while the other grasps around the ankle.
Then the lower leg is rotated inwards or outwards with force. Pain in the knee during inner rotation indicates damage to the outer meniscus, while the inner meniscus is affected during outer rotation. Steinmann II: With Steinmann II, the knee is stretched and the patient feels for pain points on the side of the joint.
Once these are found, the patient is allowed to bend the knee while continuing to search for pressure pain points. If the pain point moves further backwards, this indicates an injury to the meniscus on the same side.
- Payr: Another meniscus test that is quick and informative is the Payr test. The person affected sits cross-legged while the examiner presses down the externally rotated knee joints in a springy manner.
The Payr meniscus test is positive if pressure causes pain on the inside of the knee joint. In this case, damage to the inner meniscus is obvious. The Payr test can also be performed in a lying position by placing the outer ankle of the affected leg behind the knee of the other leg.
- McMurray: The meniscus test after McMurray is a sensitive test for meniscus damage.
The procedure for McMurray is similar to the test according to Steinmann. The patient lies on his back.According to McMurray, the examiner lifts the affected leg and bends it in the knee joint, while the thumb and index finger of one hand palpates the joint space of the knee. In this meniscus test, the knee is rotated externally to test the inner meniscus and vice versa.
Then the leg is slowly stretched while constantly feeling the joint gap. If pain occurs here, McMurray is positive and a meniscus lesion on the painful side is likely. In addition, McMurray also notices a noticeable clicking in the gap, which is also an indication of damage.
- Apley: The test according to Apley is a meniscus test, which is performed in prone position.
In Apley, the patient lying on his stomach also bends his knee at 90° so that the foot points upwards. Then, according to Apley, the examiner exerts vertical pressure on the sole of the foot from above to put weight on the knee. At the same time, the knee joint is rotated inwards and outwards again.
If there is a corresponding damage, the outer meniscus hurts when rotating inwards and the inner meniscus when rotating outwards, Apley is positive.
- Böhler: The Böhler test is also used in practice to detect meniscus damage. This meniscus test does not work with rotation, but according to Böhler the lower leg is moved laterally against the knee. You lie on your back and the leg is stretched out.
The examiner fixes the knee and thigh and then moves the lower leg vertically through the kneecap about an imaginary axis. He abducts (tilts outwards) and adducts (tilts inwards) the lower leg. The movement is minimal, rather a pressure is exerted on the menisci.
In the Böhler test, the inner meniscus is tested in the adduction position and the outer meniscus in the abduction position. The meniscus test according to Böhler thus provides indications of damage.
A meniscus test, whether Steinmann, Payr, McMurray, Apley or Böhler, in many cases gives an indication of whether a meniscus is damaged or not. In most cases, the tests are positive for a lesion, but this does not have to be evidence of meniscus damage.
Thus, ligaments and other structures that may also be painful are tested at the same time. At the same time, a negative meniscus test does not exclude the presence of damage, so the result of the meniscus test must always be seen in the overall context. Nevertheless, positive results provide sufficient reason to continue research in this direction, e.g. in the form of an MRI examination or arthroscopy.