Site Search:

Question for Physiotherapists

QUESTION | Who were McMurray and Thessaly and are their test’s useful in diagnosing and treating meniscal tears?

ANSWER | One of the most famous tests performed as part of a physical examination of the knee is called McMurray’s test. There are many variations described of exactly how to do his test and what the findings actually mean. There are also various claims regarding the sensitivity and specificity of his test. More recently Thessaly’s test has been proposed as being a more useful test than McMurray’s when looking for meniscal pathology.  

T. P. McMurray was the professor of orthopaedic surgery at Liverpool university in England. In 1940 he delivered the Robert Jones Memorial Lecture at the Royal College of Surgeons in England and this was published in the British Journal of Surgery in April 1942. The title of his lecture was “The Semilunar Cartilages”.  

At that time a plain x-ray was the only imaging modality available. A very careful clinical examination was therefore required to guide treatment (which was generally an open meniscectomy).  McMurray believed in taking a detailed history of the injury and subsequent symptoms to try to guide his diagnosis.

“From the history, and by a careful clinical examination, it is possible to diagnose most of the semilunar cartilage lesions in which the injury has occurred anterior to the lateral ligaments. Tears or displacements posterior to this point produce so few of the classical signs and symptoms that other methods of examination are necessary for their elucidation. In this connexion the use of manipulation of the injured joint has proved itself of value.”

McMurray emphasised that the severity of the lesion could not be gauged by the degree of tenderness to palpation: “in fact, a strain may give rise to extreme localized tenderness, while a complete rupture of the cartilage at the same point may be comparatively free”.   

He also stated: “The absence of tenderness must not be taken as a contra-indication to the diagnosis of a cartilage lesion because, although usually present after the injury, it tends to diminish, and in many cases disappear, after a few weeks, even though the underlying cartilage may be broken or displaced”.

In the next section of the lecture McMurray described his clinical evaluation of the knee in great detail. He did not rely on a single manoeuvre to make the diagnosis of a meniscal tear but used a combination of history, palpation and manipulation to guide his diagnosis. He also differentiated where he felt the location of the tear was in the meniscus based on the history and examination.

It is well worth reading his full article click here  

“Palpation - By palpation alone many abnormalities may be diagnosed. The palpation must be continued during the full range of movements of the joint, as only by this means can such conditions as slipping of one of the hamstring muscles round the femoral condyles or biceps tendon over the head of the fibula be fully appreciated.”

His description of the test that has been modified many times follows:        
“In carrying out the manipulation with the 
patient lying flat, the knee is first fully flexed 
until the heel approaches the buttock; the foot 
is then held by grasping the heel and using the 
forearm as a lever. The knee being now steadied 
by the surgeon’s other hand, the leg is rotated on 
the thigh with the knee still in full flexion. During this movement the posterior section of the cartilage is rotated with the head of the tibia, and 
if the whole cartilage, or any fragment of the 
posterior section, is loose, this movement produces an appreciable snap in the joint. By external rotation of the leg the internal cartilage is tested, and by internal rotation any abnormality of the posterior part of the external cartilage can be appreciated. By altering the position of flexion of the joint the whole of the posterior segment of the cartilages can be examined from the middle to their posterior attachments. 
Thus, if the leg is rotated with the knee at right angles the cartilages in their mid-section come under pressure but anterior to this point, the pressure exerted on the cartilage is so diminished that accurate examination is impossible. When a loose segment is caught….. a thud or click, which can sometimes be heard but can always be felt……   

As a summary: Probably the simplest routine is to bring the leg from it’s position of acute flexion to the right angle, whilst the foot is retained first in full internal and then full external rotation. Any abnormality …….. will be discovered during the straightening of the joint” 

This simple description has been modified many times over the years varying from starting in extension and ending in flexion to including joint line tenderness, with or without a clunk. It is worth noting that McMurray was not looking for tenderness or pain during this part of the examination. 

He then points out that “This method is not described as a counter to the ordinary methods of examination of the joint, but rather as a useful accessory.”   

Thessaly’s test:  was described in 2005 in an article published in The Journal of Bone and Joint Surgery.  The study was from the Orthopaedic Department, University of Thessaly, Larissa, Hellenic Republic, Greece which explains where the name Thessaly came from. This is in the northern side of Greece between Macedonia, Sterea, Epirus and the Aegean Sea and is a region rather than a person.   

They compared 213 symptomatic patients with 197 asymptomatic volunteers and described the Thessaly test at 5 and 20 degrees of knee flexion. MRI and arthroscopic findings were used in their analysis. Their findings indicated low rates of false positive and false negative tests with a very high degree of accuracy for both medial and lateral meniscal tears.    

“The Thessaly test is a dynamic reproduction of load transmission in the knee joint and is performed at 5° and 20° of flexion. The examiner supports the patient by holding his or her outstretched hands while the patient stands flatfooted on the floor. The patient then rotates his or her knee and body, internally and externally, three times, keeping the knee in slight flexion (5°). Then the same procedure is carried out with the knee flexed at 20°. Patients with suspected meniscal tears experience medial or lateral joint-line discomfort and may have a sense of locking or catching. The theory behind the test is that, with this manoeuvre, the knee with a meniscal tear is subjected to excessive loading conditions and almost certainly will have the same symptoms that the patient reported. The test is always performed first on the normal knee so that the patient may be trained, especially with regard to how to keep the knee in 5° and then in 20° of flexion and how to recognize, by comparison, a possible positive result in the symptomatic knee.” 

A word of caution when performing this test though: “When the Thessaly test was performed at 20° of flexion, seven (3.3%) of the patients … had a clinically important exacerbation of knee symptoms, requiring the administration of analgesic tablets, and one patient had the knee lock, requiring manipulation with the patient under anaesthesia in order to unlock it” 

Since then multiple studies have compared McMurray’s test to Thessaly’s test with differing claims of usefulness of both tests. Unfortunately, these days many people are relying solely on MRI scanning to make the diagnosis of a meniscal tear without correlating this with the patient’s history and clinical examination. While an MRI is useful, it should be reserved for situations in which the clinician requires further information before arriving at a diagnosis. Indications for arthroscopy should be therapeutic and not based purely on radiographic findings.   


Definite indications for surgery include longitudinal vertical tears (especially in the red-white or red-red zones) which are amenable to repair, horizontal cleavage tears in young athletes, hidden posterior capsulo-meniscal tears in ACL injuries, radial tears and root tears.   

Many patients will do very well with non-operative treatment even when they have a meniscal tear. This is particularly true of the more degenerative tears in older patients.  Deciding who to operate on for a meniscus tear cannot be based on a single test alone. A careful history and a combination of various clinical tests combined with advanced imaging makes the decision more clear. Unless the knee is actually locked or the tear type is included in the list above, a period of non-operative treatment is usually indicated to see if surgery can be avoided.


Dr Doron Sher

If you are a physiotherapist and wish to be sent the Question for Physiotherapists or you would like to submit a Question please email including your name and practice. 

Previous Question for Physiotherapists:

May-2018  AC Joint Dr Doron Sher 
Apr-2018 Arthritis of the fingers  Dr Kwan Yeoh 
Feb-2018 CLAVICLE fractures Dr Doron Sher 
Oct-2017 ACL Grafts  Dr Doron Sher 
Sep-2017  Forefoot pain Dr John Negrine 
Aug-2017 Wrist Ganglion
Dr Kwan Yeoh 
Jul-2017 Anterolateral Ligament Reconstruction  Dr Doron Sher 
Jun-2017  Scapholunate ligament Dr Kwan Yeoh 
Apr-2017  Knee Brace - ACL Reconstruction Dr Doron Sher 
Mar-2017 Sesamoid fractures  Dr Kwan Yeoh 
Feb-2017  Plantar Fasciitis
Dr Todd Gothelf
Nov-2016  Sternoclavicular Joint Dr Doron Sher 
Oct-2016  Proximal Humerus Fractures Dr David Lieu 
Sep-2016 Wrist Fractures  Dr Kwan Yeoh 
Aug-2016  Patella Instability Dr Doron Sher 
Jul-2016 Snowboarders ankle
Dr Todd Gothelf
May-2016  Cortisone Injections Dr Paul Annett 
Apr-2016 Shoulder Instability_1  Dr Ivan Popoff 
Mar-2016 Exercise after TKR  Dr Doron Sher 
Dec-2015 Scaphoid OA Dr Kwan Yeoh 
Nov-2015  Greater Tuberosity Fractures Dr Doron Sher
Oct-2015 Stress Fractures  Dr Paul Annett
Boxers Fractures
Dr Kwan Yeoh
Aug 2015
Resistance Training  Dr John Best
July 2015 LARS Ligament
Dr Ivan Popoff
Distal Biceps  Dr Doron Sher
May-2015 Latarjet procedure
Dr Jerome Goldberg
Apr-2015 TFCC Questions  Dr Kwan Yeoh 
Mar-2015  Acute Ankle Sprains
Dr Todd Gothelf
Nov-2014  PRPP Dr Paul Annett
Oct-2014 Driving After Surgery
Dr Doron Sher
Sep-2014  Distal Biceps Rupture Dr Doron Sher
Aug-2014 Ankle Sprain
Dr Todd Gothelf
Jun-2014  Patella Dislocation Dr Doron Sher
May-2014  Shoulder Instability Dr Todd Gothelf
Apr-2014  De Quervains Dr Kwan Yeoh
Acromio-clavicular joint injuries
Dr Todd Gothelf
Feb-2014 Chronic Knee Pain
Dr Paul Annett
Dec-2013 Foot and Ankle Questions  Dr John Negrine
Oct-2013 Rotator Cuff Repair  Dr Todd Gothelf
Sep-2013  ACL Reconstruction
Dr Doron Sher
Jul-2013 Slipped Upper femoral epiphysis  Dr Rod Pattinson
May-2013 Skiers thumb Dr Kwan Yeoh
Apr-2013  Bakers_Cyst
Dr Ivan Popoff


 Tibial Osteotomy vs UKR

Dr Doron Sher 

 ALIF success rate

Dr Andreas Loefler


 Lisfranc Injuries

Dr Todd Gothelf 

 Anterior Spinal Fusions

Dr Andreas Loefler 

 MCL Injuries

Dr Doron Sher 

Compartment Syndrome

Dr Paul Annett 

 Carpal tunnel

Dr Kwan Yeoh 

 Anterior Process Calcaneus Fx

Dr Todd Gothelf 

 Tenodesis vs Tenotomy

Dr Jerome Goldberg 


 Osteoarthritis in the young active patient Dr Doron Sher 

 Syndesmosis Sprain

Dr Todd Gothelf 


 Triangular Fibrocartilage Injuries

Dr Kwan Yeoh 

 Shoulder Replacement Older Population

Dr Jerome Goldberg



 Wrist Fracture

Dr Kwan Yeoh 



 Adductor Tendon Tear

Dr Paul Annett 

 Navicular Pain 

Dr Todd Gothelf 

 OCD Lesion

Dr Doron Sher 

 Metal on Metal Hip Replacements

Dr Andreas Loefler 

 Femoral Neck Stress Fract (Pt 2)

Dr John Best 


 Femoral Neck Stress Fractures

Dr John Best 

 PCL Injury Part 2

Dr Doron Sher 

 PCL Injury Part 1

Dr Doron Sher 

 Prolotherapy Autologous Blood Injections

Dr Paul Annett 

 Shoulder Impingement

Dr Todd Gothelf 

 Does Chondral Grafting Work

Dr Doron Sher 

 Shoulder Immobilisation-Dislocation

Dr Jerome Goldberg

SLAP Lesions Stable Shoulder

Dr Todd Gothelf 

 Ankle Sprains

 Dr Todd Gothelf


 Dislocation After THR

 Dr Peter Walker


 Acupuncture Muscle Strength Programmes

 Dr Paul Annett


 Full Thickness Rotator Cuff Tears

Dr Jerome Goldberg


 Skiing after TKR

 Prof Warwick Bruce


 Fractures of the Clavicle

 Dr John Trantalis


 Osteoarthritis of the Knee

 Dr Doron Sher


 Fifrth Metatarsal Fractures

 Dr Todd Gothelf


Partial Rotator Cuff Tears

Dr Todd Gothelf

Copyright © 2009 Orthosports
Elbow Arthroscopy - Hip Arthritis - ACL Reconstruction

Orthopaedic Surgeon - Knee Reconstruction - ACL tear - Osteotomy
Orthopaedic Surgeon

Enter your email address:
CONCORD 02 9744 2666 | HURSTVILLE 02 9580 6066 | PENRITH 02 4721 7799 | RANDWICK 02 9399 5333 | BELLA VISTA 02 9744 2666
Copyright © 2009 Orthosports