The Steinmann Test is a knee orthopaedic test used to assess whether tibial rotation reproduces joint-line pain that may be associated with meniscal irritation or meniscal injury. A positive result may increase suspicion of meniscal involvement when it matches the client’s history and other findings, but it does not confirm a meniscal tear on its own.
Meniscal injuries can contribute to knee pain, swelling, catching, locking, clicking, giving way and reduced confidence with twisting or loaded knee flexion.
The Steinmann Test is a rotational knee test used to assess whether internal or external tibial rotation reproduces pain around the medial or lateral joint line.
It is commonly used alongside:
McMurray Test
Apley Compression Test
Thessaly Test
joint-line tenderness
knee swelling assessment
range of motion testing
squat or step-down assessment
history of twisting injury
imaging where clinically appropriate
The current MAT page appears to describe the Steinman Test as related to medial collateral ligament injury, but most clinical education sources describe Steinmann testing as a meniscal assessment involving tibial rotation and joint-line symptom reproduction.
Test name: Steinmann Test
Also known as: Steinman Test, Steinmann Sign, Steinmann I / Steinmann II
Body region: Knee
Purpose: Assess joint-line pain during tibial rotation
Commonly associated presentation: Meniscal irritation or suspected meniscal tear
Positive finding: Familiar medial or lateral joint-line pain during tibial rotation
Negative finding: No familiar joint-line pain during controlled tibial rotation
Best used with: McMurray Test, Apley Compression Test, Thessaly Test, joint-line tenderness and history
Key limitation: Diagnostic accuracy is variable and should not be used as a stand-alone diagnosis
The Steinmann Test is a knee special test used to assess symptom response during tibial rotation.
It is commonly described in two parts:
Steinmann I: pain is assessed during internal and external tibial rotation with the knee flexed
Steinmann II: tenderness is assessed as the knee moves from flexion to extension, with meniscal-related tenderness described as shifting with knee position
This article focuses mainly on the commonly used Steinmann I rotational test because it is more practical for Measurz recording and professional education.
The test may help assess whether rotational loading of the meniscus reproduces familiar joint-line symptoms.
The Steinmann Test may help support assessment reasoning when meniscal involvement is suspected.
It may help professionals:
assess medial or lateral joint-line pain
compare the symptomatic and non-symptomatic knee
identify whether tibial rotation reproduces familiar symptoms
document pain location and symptom quality
guide further meniscal testing
support referral or imaging discussion where appropriate
monitor symptom irritability over time
The test should not be used alone to diagnose or exclude a meniscal tear.
The Steinmann Test assesses symptom response to tibial rotation at the knee.
It may provide information about:
medial joint-line pain
lateral joint-line pain
pain during tibial internal rotation
pain during tibial external rotation
side-to-side symptom difference
symptom familiarity
irritability during rotational loading
It does not directly identify:
exact meniscal tear location
tear size
tear type
meniscal stability
cartilage injury
ligament injury
mechanical obstruction
whether surgery is required
This test may be useful for:
exercise professionals
rehabilitation practitioners
strength and conditioning coaches working with allied health teams
performance coaches
movement assessment professionals
students learning knee assessment
professionals using Measurz or MAT for structured assessment recording
It may be relevant for clients who report:
joint-line knee pain
twisting injury
pain during pivoting
clicking or catching
intermittent locking
swelling after activity
pain with squatting
pain during kneeling or loaded flexion
Use the Steinmann Test when the history suggests possible meniscal involvement and controlled rotational testing is appropriate.
It may be useful when the client reports:
twisting mechanism of injury
medial or lateral joint-line pain
catching or clicking
pain with deep knee flexion
pain with pivoting
swelling after rotational activity
difficulty with squatting, kneeling or turning
The test is more meaningful when it reproduces the client’s familiar joint-line symptoms.
Use caution with:
acute traumatic knee injury
large swelling or suspected haemarthrosis
suspected fracture
locked knee
suspected major ligament injury
recent knee surgery
severe pain
high irritability
marked guarding
inability to tolerate knee flexion
Stop testing if:
sharp pain occurs
symptoms escalate quickly
the knee locks
the client feels unsafe
guarding prevents controlled rotation
the client asks to stop
Treatment table or plinth
Pain scale
Symptom location notes
Measurz recording workflow
Optional comparison-side notes
Optional referral or imaging notes where appropriate
Position the client in supine lying.
Explain the test clearly before starting.
The client should understand that the aim is to assess symptom response during controlled lower-leg rotation, not to force the knee.
Client lies on their back
Hip and knee are flexed
Knee is commonly flexed around 90 degrees
Foot and lower leg are relaxed
Compare both sides where appropriate
Stand or sit beside the tested knee
Support the knee with one hand
Hold the lower leg or foot with the other hand
Keep the movement slow and controlled
Common hand placement includes:
one hand stabilising the distal thigh or knee
one hand holding the ankle, heel or lower leg
optional palpation of the joint line to confirm symptom location
Avoid excessive pressure over painful areas.
Monitor for:
hip rotation
pelvic movement
muscle guarding
quadriceps tension
hamstring tension
ankle substitution
facial expression
withdrawal response
The knee should remain controlled while the tibia is rotated.
Perform controlled tibial rotation with the knee flexed.
Common interpretation is:
External tibial rotation: may reproduce symptoms more commonly associated with the medial meniscus
Internal tibial rotation: may reproduce symptoms more commonly associated with the lateral meniscus
Use caution with this directional interpretation. Pain location and symptom familiarity are more important than rotation direction alone.
Ask the client to:
stay relaxed
report pain or discomfort
identify the exact pain location
say whether the symptom is familiar
rate pain from 0–10
tell you if they want the test stopped
Example instruction:
“I’m going to gently rotate your lower leg while your knee is bent. Tell me if this reproduces your familiar knee pain, where you feel it, and whether it feels like your usual symptoms.”
A positive Steinmann Test may include:
familiar medial joint-line pain
familiar lateral joint-line pain
pain during tibial rotation
clicking or catching with familiar pain
clear side-to-side difference
guarding due to familiar joint-line symptoms
The most meaningful positive finding is familiar joint-line pain, not vague discomfort.
A negative finding involves:
no familiar joint-line pain
no meaningful pain during tibial rotation
no catching or locking sensation
no clear side-to-side difference
smooth tolerance of the movement
Stop if:
pain becomes sharp
symptoms escalate quickly
the knee catches or locks
the client becomes highly apprehensive
guarding prevents safe movement
the client asks to stop
Use slow and controlled rotation
Do not force end range
Avoid repeated provocation in irritable knees
Record whether pain, clicking, catching or locking occurred
Record whether symptoms were familiar
A positive Steinmann Test may increase suspicion of meniscal involvement when controlled tibial rotation reproduces familiar joint-line pain.
A positive result is more meaningful when it matches:
twisting injury mechanism
joint-line tenderness
swelling after activity
catching or locking symptoms
pain with squatting or kneeling
positive McMurray Test
positive Apley Compression Test
positive Thessaly Test
imaging findings where clinically appropriate
A positive result does not confirm a meniscal tear on its own.
Other factors may contribute to pain during the test, including:
patellofemoral pain
collateral ligament irritation
osteoarthritis
synovitis
capsular sensitivity
bone bruising
general knee irritability
recent training or loading spike
poor relaxation during testing
A negative result may reduce suspicion when:
the test is performed well
the client is relaxed
there is no joint-line pain
related meniscal tests are also negative
the history is not strongly suggestive of meniscal involvement
However, a negative Steinmann Test does not fully exclude meniscal injury.
Some clients may only report symptoms during:
loaded twisting
deep squatting
kneeling
sport-specific pivoting
fatigue
repeated activity
higher-speed change of direction
Interpretation is stronger when combined with history, swelling, joint-line tenderness, McMurray, Apley, Thessaly, functional testing and imaging where appropriate.
Diagnostic accuracy evidence for the Steinmann Test is less extensive than for some other meniscal tests.
A 2017 study comparing clinical tests and MRI with video arthroscopy reported that the Steinmann I Test was highly specific for meniscal tears, with specificity of:
86% for medial meniscus tears
91% for lateral meniscus tears
This suggests that a clearly positive Steinmann I Test may increase suspicion of meniscal involvement in the right clinical context. However, specificity alone does not confirm a tear, and performance depends on the population, examiner technique and reference standard.
Some clinical summaries report more modest values, with sensitivity around 59–70% and specificity around 44–56%, highlighting that estimates vary and should be interpreted cautiously.
Broader systematic review evidence for meniscal special tests has found that the diagnostic accuracy of individual tests is variable and sometimes unclear. Meniscal assessment is generally stronger when multiple findings are considered together rather than relying on one test.
Practical interpretation:
A positive Steinmann Test may increase suspicion when it reproduces familiar joint-line pain.
A negative Steinmann Test does not exclude meniscal injury.
Diagnostic accuracy varies by study, test variation, examiner skill, population and reference standard.
Clusters of findings are usually more useful than one test result.
The result should be interpreted with history, swelling, joint-line tenderness, other meniscal tests and imaging where relevant.
Specific reliability values for the Steinmann Test appear limited.
Reliability may be influenced by:
knee flexion angle
tibial rotation range
movement speed
examiner hand placement
client relaxation
pain irritability
whether familiar pain is required
whether clicking without pain is treated as positive
side-to-side comparison
examiner experience
Validity is stronger when:
the test reproduces familiar joint-line pain
pain location is clearly medial or lateral
symptoms match the injury history
related meniscal tests are also positive
swelling or mechanical symptoms are present
functional tasks reproduce similar symptoms
imaging findings, where relevant, support the broader picture
Validity is weaker when:
pain is vague or non-familiar
pain is not joint-line based
the client guards strongly
the knee is highly irritable
symptoms are better explained by patellofemoral, ligament, capsular or osteoarthritic factors
Recent evidence also suggests that clinical tests for meniscal injury can be inconsistent when used alone, while composite testing may improve diagnostic value. One study reported improved diagnostic value when at least two clinical tests were positive, with sensitivity, specificity and accuracy improving for both medial and lateral meniscal injury.
Common errors include:
rotating too aggressively
forcing end range
not confirming pain location
not asking whether pain is familiar
interpreting any discomfort as positive
ignoring clicking that is painless or non-familiar
not comparing both sides
failing to record knee flexion angle
not recording rotation direction
using the test as a stand-alone diagnosis
Limitations include:
limited exact-test reliability evidence
variable diagnostic accuracy
symptom overlap with other knee conditions
difficulty interpreting vague pain
reduced usefulness in acutely swollen or guarded knees
does not identify tear type, size or stability
not a stand-alone replacement for imaging or professional judgement
The Steinmann Test may help professionals:
assess joint-line pain during tibial rotation
compare symptomatic and non-symptomatic knees
identify whether symptoms are familiar
document rotational irritability
guide further meniscal testing
support referral or imaging discussion where appropriate
monitor symptom response over time
For athletes, it may be used alongside:
twisting injury history
squat assessment
change-of-direction assessment
hop or landing testing when appropriate
training load review
sport-specific movement assessment
For general population clients, it may help explore symptoms during:
kneeling
squatting
turning
stairs
getting in and out of a car
uneven-ground walking
For Measurz users, the main value is consistent recording of test variation, pain location, rotation direction, symptom familiarity and related findings.
Record:
test name: Steinmann Test
side tested: left, right or both
result: positive, negative, unclear or unable to test
test variation: Steinmann I or Steinmann II if specified
client position
knee flexion angle
rotation direction: internal or external tibial rotation
pain score from 0–10
symptom location: medial joint line, lateral joint line or other
symptom quality
whether the symptom was familiar
clicking, catching or locking if present
guarding or apprehension
comparison side
irritability level
reason for stopping if stopped early
related findings, such as McMurray, Apley, Thessaly, joint-line tenderness or swelling
interpretation notes
planned retest date if monitoring change
Record whether the main response was:
familiar medial joint-line pain
familiar lateral joint-line pain
clicking with pain
clicking without pain
catching
locking
pain in another location
no symptoms
unclear response
unable to test safely
This improves:
repeatability
communication
client education
assessment reasoning
team consistency
progress monitoring
reporting quality
McMurray Test
Apley Compression Test
Thessaly Test
Joint-Line Tenderness
Sweep Test
Knee Range of Motion Tests
Single-Leg Squat Test
Step-Down Test
It assesses whether tibial rotation reproduces familiar medial or lateral joint-line pain that may be associated with meniscal involvement.
A positive result may include familiar joint-line pain during internal or external tibial rotation.
No. It may increase suspicion of meniscal involvement, but it does not confirm a meniscal tear on its own.
No. A negative result does not fully exclude meniscal injury, especially if symptoms only occur during loaded twisting, deep squatting or sport-specific movement.
External tibial rotation is commonly associated with medial meniscus symptom provocation, while internal tibial rotation is commonly associated with lateral meniscus symptom provocation. Pain location and symptom familiarity are more important than direction alone.
Clicking is more meaningful when it is painful, familiar and located around the joint line. Painless clicking should be recorded but interpreted cautiously.
It is best used with history, joint-line tenderness, McMurray Test, Apley Compression Test, Thessaly Test, swelling assessment, functional testing and imaging where appropriate.
The Steinmann Test is commonly used as a meniscal assessment test.
It assesses joint-line pain during tibial rotation.
A positive result may involve familiar medial or lateral joint-line pain.
It does not confirm a meniscal tear on its own.
Diagnostic accuracy estimates vary, and exact-test reliability evidence appears limited.
Interpretation is stronger when combined with history, swelling, joint-line tenderness, McMurray, Apley, Thessaly, functional testing and imaging where relevant.
Measurz should record side, test variation, knee angle, rotation direction, pain location, pain score, symptom familiarity and related findings.
Blyth, M., Anthony, I., Francq, B., Brooksbank, K., Downie, P., Powell, A., Jones, B., MacLean, A., McConnachie, A., Norrie, J., & Robb, J. (2015). Diagnostic accuracy of the Thessaly test, standardised clinical history and other clinical examination tests for meniscal tears in comparison with magnetic resonance imaging diagnosis. Health Technology Assessment, 19(62), 1–62. https://doi.org/10.3310/hta19620
Cardoso, D. M., Neves, L. S., & Silva, M. V. (2017). Evaluation of clinical tests and magnetic resonance imaging for knee meniscal injuries: Correlation with video arthroscopy. Revista Brasileira de Ortopedia, 52(5), 582–588. https://doi.org/10.1016/j.rboe.2017.08.008
Hegedus, E. J., Cook, C., Hasselblad, V., Goode, A., & McCrory, D. C. (2007). Physical examination tests for assessing a torn meniscus in the knee: A systematic review with meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 37(9), 541–550. https://doi.org/10.2519/jospt.2007.2560
Meserve, B. B., Cleland, J. A., & Boucher, T. R. (2008). A meta-analysis examining clinical test utilities for assessing meniscal injury. Clinical Rehabilitation, 22(2), 143–161. https://doi.org/10.1177/0269215507080130
Smith, B. E., Thacker, D., Crewesmith, A., & Hall, M. (2015). Special tests for assessing meniscal tears within the knee: A systematic review and meta-analysis. Evidence-Based Medicine, 20(3), 88–97. https://doi.org/10.1136/ebmed-2014-110160
Tran, V. Q., Nguyen, T. T., & Nguyen, T. D. (2021). Diagnostic value of clinical tests and MRI for meniscal injury in patients with anterior cruciate ligament injury. International Journal of Surgery Case Reports, 88, 106511. https://doi.org/10.1016/j.ijscr.2021.106511
