1/10/2024 0 Comments Knee effusion![]() ![]() Īn ultrasound of the effusion can help assess a complicated effusion from a simple effusion and can also be used to perform arthrocentesis. Another reason for plain radiographs is to detect erosive disease found in rheumatoid arthritis (RA) or joint space narrowing found both in osteoarthritis and RA. The same lateral knee radiograph may show an increased opacity and widening of the suprapatellar bursa, which should be assessed if the fabella sign is seen. The fabella sign or displacement of the fabella is seen with a synovial effusion and popliteal mass. It is a radio-opaque marker for the posterior border of a knee's synovium. A fabella, a sesamoid bone located inside the gastrocnemius, may be seen on an x-ray. This includes AP, lateral, and axial views. ![]() In patients presenting with an acutely swollen knee, weight-bearing radiographs in 3 planes should be ordered to look for a fracture in the case of trauma. In septic arthritis, the following symptoms are the only ones to occur in more than 50% of patients: joint pain, a history of joint swelling, and fever. Always compare the exam with the unaffected knee. The ballottement test is done by pressing upward on the medial aspect of the knee 2 to 3 times, then tapping the lateral patella to see if it floats outward due to effusion. īoth the ballottement test and bulge test are done to look for knee effusion. The patellofemoral joint test (compression test) indicates pathology in the patellofemoral compartment. Special tests include the McMurray tests and Thessaly test for the medial and lateral meniscus, Lachman's and anterior drawer tests for an ACL tear, posterior drawer test for a PCL tear, and varus and valgus stress tests for LCL and MCL injuries, respectively. The exam should include evaluation of the skin, observation of gait, palpation of the external knee structures, active and passive range of motion, joint line tenderness, and special testing. Patients may have a restricted range of motion and pain with ambulation. These red flags typically need immediate evaluation.Ī knee joint effusion will demonstrate swelling around the patella and distention of the suprapatellar bursa. Red flags include fever, non-weight bearing, loss of distal pulses, loss of sensation distal to the knee, open fractures, and cellulitis overlying the knee. A large effusion can result in an inability to completely extend the knee, typically resting with 15 degrees of flexion. Patients commonly complain of swelling and stiffness with decreased range of motion. A history of previous surgery should be determined in every patient who presents with knee swelling. In contrast, an atraumatic effusion would have a higher suspicion of infection or systemic disease. A knee effusion with a recent injury history may suggest an internal derangement such as a ligament or meniscal tear. Important questions include mechanism of injury, duration, acuity of onset, previous history of the joint, aggravating symptoms, and any associated systemic symptoms. The evaluation of an acutely swollen knee must begin with a very thorough history and examination of the affected knee and contralateral knee. ![]()
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