I work as a physician’s assistant in a small, rural town in the west. We can do X-rays in our clinic, but we don’t have a hospital, which means no CT scan and no MRIs. Is there a reliable test I can use to look for meniscal tears before sending the patients to the next large town for further tests?

There are several common orthopedic tests done in the clinic for meniscal tears. Joint line tenderness is 89 percent accurate in finding lateral meniscal tears. McMurray’s test is a popular one. The patient is lying on his or her back. The examiner puts mild compressive stress in a valgus or varus direction. This is done while moving the knee from a bent to straight position and rotating the tibia.

Any loose fragments or tears in the meniscus will cause a snap or click. This response is often painful for the patient.

Another test is Apley’s compression and distraction. This test is done with the patient lying face down. The knee is bent 90 degrees. The examiner uses his or her knee to gently, but firmly, hold the patient’s thigh down. The tibia (lower leg) is distracted and the foot is used to turn the tibia in and out. Look for any catching, pain, or restricted movement. The test is repeated with the tibia compressed (push down on the foot while rotating in and out).

Any changes while the knee is compressed are likely to be meniscus. Positive signs with distraction and rotation may be ligamentous.

A new test called the Thessaly test has been shown to be 94 to 96 percent accurate. The patient stands barefoot on one leg (test the normal leg first). While holding the examiner’s hands or a stationary object, the patient bends the knee five degrees and keeps it there while rotating the knee and body internally and externally, three times.

The same test is repeated with the knee bent 20 degrees. Patients with meniscal injuries are likely to have joint-line pain or discomfort during this movement. There maybe a sense of locking or catching. Beware that in the rare case the knee can get locked up and require surgery to unlock it.