McMurray’s sign is a clinical indicator commonly associated with medial meniscal injury of the knee. It is elicited as a palpable or audible click when rotating the tibia on the femur. The click occurs when a torn meniscal fragment is trapped between the tibial plateau and femoral condyles and then suddenly releases. Caution: this maneuver is contraindicated in patients with suspected tibial plateau or femoral condyle fractures, as manipulation may exacerbate injury.

A positive McMurray’s sign is often accompanied by joint line tenderness, locking or catching of the knee, and decreased range of motion (ROM).

History and Physical Examination

• Ask about acute knee pain and describe the nature of any recent injury.

• Determine mechanism of injury: twisting, blunt trauma, or prior knee injuries.

• Ask about previous surgeries, prosthetic replacements, or joint disorders (e.g., arthritis).

• Inquire if any activities aggravate or relieve pain, and if the patient needs assistance walking.

• Have the patient point to the area of maximal pain.

• Assess range of motion: passive and active, with resistance.

• Test cruciate ligament stability (anterior/posterior drawer sign).

• Measure quadriceps muscle symmetry in both legs.

Examination Tip: Eliciting

McMurray’s Sign

• Place the patient supine with the knee flexed until the heel nearly touches the buttock.

• Place fingers along the knee joint space and grasp the heel.

• Rotate the foot and lower leg laterally to test the posterior medial meniscus.

• While keeping the foot lateral, extend the knee to ~90° to test the anterior medial meniscus.

• A palpable or audible click indicates a positive McMurray’s sign, suggesting meniscal injury.

Medical Causes

Special considerations

• Prepare for diagnostic imaging: knee X-rays, MRI, arthroscopy, or arthrography.

• Obtain previous imaging for comparison if available.

• In acute trauma, monitor for effusion or hemarthrosis, and prepare for joint aspiration if needed.

• Apply immobilization, ice, and supportive devices (cast or knee brace).

Patient counseling

• Explain elevation of the affected leg and proper use of assistive devices.

• Teach knee exercises to maintain ROM and strengthen muscles.

• Educate on analgesics and anti-inflammatory drugs for pain management.

• Discuss lifestyle modifications to prevent re-injury.

Pediatric pointers

• McMurray’s sign in adolescents is most commonly due to sports-related meniscal tears.

• In children, it may also indicate a congenital discoid meniscus, which predisposes to tears.

References

1. Amorim JA, Remigio DS, Damazio Filho O, Barros MA, Carvalho VN, Valenca MM. Intracranial subdural hematoma post-spinal anesthesia: Report of two cases and review of 33 cases in the literature. Braz J Anesthesiol. 2010;60:620–629.

2. Machurot PY, Vergnion M, Fraipont V, Bonhomme V, Damas F. Intracranial subdural hematoma following spinal anesthesia: Case report and review of the literature. Acta Anaesthesiol Belg. 2010;61:63–66.