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Special Test

Payr Test

Payr Test is a special test used to evaluate the meniscus injury of the knee, especially the posterior horn of the medial or lateral meniscus.

How do you perform the Payr Test?

The posterior horn of the medial meniscus is tested as following:

With the patient is in supine position, the examiner immobilizes the patient’s knee with one hand and palpates the lateral and medial joint cavity with the thumb and index finger, respectively. With the other hand, the examiner grasps the patient’s ankle. With the knee maximally flexed, the lower leg is externally rotated as far as possible. Then with the knee in slight adduction (varus stress), the leg is flexed further in the direction of the contralateral hip.

See Also: McMurrey Test
Payr Test with external rotation
Payr Test with External Rotation

The posterior horn of the lateral meniscus is tested as following:

The patient in supine position, the examiner immobilizes the patient’s knee with one hand and palpates the lateral and medial joint cavity with the thumb and index finger, respectively. With the other hand, the examiner grasps the patient’s ankle. With the knee maximally flexed, the lower leg is internally rotated and abducted (valgus stress), the leg is flexed further in the direction of the contralateral hip.

Payr Test with internal rotation
Payr Test with Internal Rotation

What is the positive Payr test?

Pain in the posterior medial joint cavity suggests damage to the medial meniscus (most often the posterior horn is involved, which is compressed by this maneuver).

While pain in the posterior lateral joint cavity suggests damage to the posterior horn of the lateral meniscus.

See Also: Knee Meniscus Tear

Payr Sign

The patient is seated cross-legged. The examiner exerts intermittent pressure on the affected leg, which is flexed and externally rotated.

Pain in the medial joint cavity suggests meniscus damage (usually a lesion of the posterior horn). Occasionally, patients them selves will be able to provoke snapping. Moving the knee back and forth causes the injured portion of the meniscus to be drawn into the joint and then spring back out with a snap when the joint cavity is distended.

In a study by Jerosch and Riemer, this test was found to have a sensitivity of 54% and a specificity of 44%, demonstrating a diagnostic value similar to that of a coin toss.

Payr Sign
Payr Sign

References

  1. Jerosch J, Riemer S. Wie gut sind klinische Untersuchungsverfahren zur Diagnostik von Meniskusläsionen? [How good are clinical investigative procedures for diagnosing meniscus lesions?]. Sportverletz Sportschaden. 2004 Jun;18(2):59-67. German. doi: 10.1055/s-2004-813228. PMID: 15164290.
  2. Clinical Tests for the Musculoskeletal System 3rd Edition.
  3. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.

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