Detecting a slight hydrops of the knee. The knee of a 55-year-old woman became painful repeatedly with exertion. An X-ray showed a slight narrowing of the joint space as a sign of incipient osteoarthritis. On clinical examination, slightly increased amount of fluid in the joint was detected by the bulge sign test, which involves first pressing the fluid away from the outer side of the knee with the fingers at the level of the upper edge of the kneecap, and then squeezing the fluid back from the other side of the knee, which can be seen as a bulge. The test should be repeated several times to ensure that the bulge is not due to displacement of the kneecap. This test is even more sensitive than the test where the fluid is alternately pressed into the upper recess and under the patella (video Detecting Hydrops of the Knee).
Video and text: Ilkka Kunnamo
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