Steinman Test

What is the medial collateral ligament (MCL)?

The medial collateral ligament (MCL), also known as the tibial collateral ligament, is a broad band of connective tissue on the inner side of the knee. It extends from the medial epicondyle of the femur to the medial condyle of the tibia (Navqi & Sherman, 2020). The MCL provides valgus stability to the knee joint, protecting it from inward collapse. It plays a crucial role in preventing excessive medial rotation and medial pain associated with meniscal injuries, including medial meniscus and lateral meniscus damage.

What is an MCL injury?

An MCL injury involves damage to the medial collateral ligament, a structure that stabilizes the inner side of the knee (Penn Medicine, 2022). It occurs when excessive stress or pressure is applied to the outer knee, causing the ligament to stretch, partially tear, or completely tear. MCL injuries are often accompanied by meniscal injuries, such as meniscus tears, due to their close anatomical relationship.

Common symptoms include knee swelling, pain, and tenderness along the joint's inner side, especially when the knee is flexed. These injuries may also cause instability or locking of the knee. Diagnosing meniscal injuries is critical when assessing meniscal injury in MCL cases, as concurrent damage can complicate treatment. Understanding the connection between MCL injuries and meniscal tears helps healthcare providers manage knee conditions effectively.

What is the Steinman Test?

The Steinman Test (also known as the Steinman tenderness displacement test) is a physical examination technique used to diagnose meniscal pathology in the knee. It evaluates pain and abnormalities in the knee joint line by testing the range of motion and assessing the presence of meniscus injuries (Gobbo et. al, 2011).

During the test, the patient is in supine position, with the examiner passively inducing 90 degrees knee flexion. External rotation of the tibia is applied to detect medial meniscus injuries, while internal rotation is applied to target the lateral meniscus. A positive test is indicated by pain along the knee joint line, with the rotation direction identifying the specific meniscus tear (Magee, 2008).

This clinical test utility is commonly performed in cases of suspected knee meniscus damage and is a valuable tool in both diagnosis and guiding physical therapy interventions. The Steinman Test helps differentiate meniscal pathology from other causes of knee pain and supports targeted treatment for the injured knee.

How to use our Steinman Test template

Carepatron's Steinman Test template simplifies diagnosing meniscal pathology by providing a structured format for assessment. Medical professionals can efficiently evaluate the knee joint, document findings, and guide treatment plans. Follow these steps to maximize the template's utility and improve patient care.

Step 1: Access the template

Open the Steinman Test template by clicking "Use template," which opens it in the Carepatron app’s template editor. From there, you can edit the template or add or delete items and fields as necessary. After that, you can fill it out digitally or print it. You can also save a non-customizable but fillable and printable PDF by clicking "Download."

Step 2: Use the template for patient assessment

Utilize the template's listed steps to administer the Steinman Test. It outlines proper positioning, internal and external rotations, and documentation of pain locations to identify potential meniscus injuries effectively.

Step 3: Gather and interpret results

Record the findings using the template's fields. Determine if the results indicate meniscal pathology, such as medial or lateral meniscus tears, and correlate them with the patient’s symptoms for accurate diagnosis.

Step 4: Provide patient education and next steps

Share the results with the patient using the template’s summary section. Offer education on the condition, discuss treatment options like physical therapy, and outline next steps to promote recovery and improve knee function.

Interpretation of findings

The interpretation of Steinman Test results involves assessing pain and tenderness during specific knee movements. In Steinman Part 1, a positive finding occurs if lateral pain is elicited during medial rotation or medial pain during lateral rotation, indicating potential meniscus tears. These patterns help differentiate between medial and lateral meniscal injuries.

For Steinman Part 2, a positive test is noted when joint line tenderness shifts posteriorly with the knee flexed. This movement of tenderness strongly suggests meniscal pathology and differentiates it from other knee conditions. Conversely, a negative finding in either test is characterized by the absence of pain or tenderness, indicating no significant meniscal injury.

Accurately interpreting these findings provides essential information for diagnosing and treating knee conditions, aiding healthcare professionals in developing tailored treatment plans for the affected knee.

Benefits of the Steinman Test

The Steinman Test offers several benefits in diagnosing knee conditions, particularly meniscal injuries. It is a simple, non-invasive clinical test that provides valuable insights into the presence and location of meniscus tears. By using specific movements, such as internal and external rotation, the test effectively identifies medial or lateral meniscus involvement, aiding in precise diagnosis. This makes it an essential tool for differentiating meniscal pathology from other knee issues, such as ligament injuries or osteoarthritis.

The test is cost-effective, requiring no advanced equipment, making it accessible in various healthcare settings. Additionally, it supports healthcare professionals in guiding further diagnostic imaging or treatment plans, such as physical therapy or surgical consultation. By facilitating early and accurate diagnosis, the Steinman Test plays a crucial role in improving patient outcomes, minimizing unnecessary interventions, and enabling targeted management of knee injuries.

Tailored treatments plans

Positive Steinman Test results indicate meniscal pathology, such as medial meniscus injuries or other meniscal tears. Treatment plans can be tailored to the severity and nature of the injury. For mild cases, conservative management may include rest, ice application, and physical therapy to restore strength and range of motion, especially during knee flexion.

For patients experiencing persistent pain or instability, additional knee orthopaedic tests or imaging may be recommended to confirm findings from the Steinman Test and other meniscal tests. Severe meniscal tears might require surgical intervention, such as arthroscopic repair or partial meniscectomy, particularly if the knee remains unstable when flexed.

Tailored treatment plans leverage clinical test utilities to address individual patient needs. Combining targeted therapy with regular monitoring ensures that interventions align with recovery goals, helping patients regain full function while preventing further complications in the affected knee.

Reference

Gobbo, R. da R., Rangel, V. de O., Karam, F. C., & Pires, L. A. S. (2011). Physical examinations for diagnosing meniscal injuries: Correlation with surgical findings. Revista Brasileira de Ortopedia (English Edition, 46(6), 726–729. https://doi.org/10.1016/S2255-4971(15)30332-3

Magee, D. J. (2008). Orthopedic physical assessment (5th edition). Elsevier.

Naqvi, U., & Sherman, A. L. (2020). Medial collateral ligament (MCL) knee injuries. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK431095/

Penn Medicine. (2022). Medial collateral ligament injury (MCL). https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/medial-collateral-ligament-mcl-injury-of-the-knee