Tuesday, September 28, 2010

Knee Effusion

-Tunisia?
-Two Knees, Yeah!
-Two Knees, Huh?

Okay...terrible...there's plenty more where that came from. Today we examined two knees. And a few knee problems - gout, prepatellar bursitis, and septic arthritis.

Is there an effusion?

1. Inspect: in the absence of an obvious effusion, have a look at the medial side of the knee - normally there is a 'dimple' here. Expose both sides and compare. Absence of this dimple is usually indicative of an effusion.

2. Palpate: There are a few ways to feel for an effusion....
  • Patellar Tap: push on the suprapatellar region to get fluid under the patella, then press firmly on the patella. You may feel it tap on the bone underneath. Kind of uncomfortable.
  • Ballotment: push on the suprapatellar region to get fluid under the patella. Then with your other hand, use your thumb and index finger to ballot the fluid back and forth.
  • "Milk" test: 'milk' (or 'sweep') fluid from the medial side up the knee and watch that medial dimple re-appear. Then sweep the fluid back down the lateral aspect of the knee and see the medial dimple bulge out again.
  • The Forgotten 4th test: Not sure what to call this one. I learned from Dr. Mary Bell, an incredible Rheumatologist. With one hand, place your index finger and thumbs on either side of the patella. Then with your index finger of your other hand, gently press on the suprapatellar area. In the presence of an effusion, you will feel pressure on your thumb and forefinger.

Let me know if you need this explained again at the bedside - happy to show you at any time.

3. Links:



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