Palpation Tests for Effusion in the Knee Joint

Three tests
 Learn to apply three tests for detecting fluid in the knee joint:
the bulge sign,
the balloon sign, and
balloting the patella.
The bulge sign (for minor effusions)
 With the knee extended, place the left hand above the knee and
apply pressure on the suprapatellar pouch, displacing or “milking”
fluid downward.
 Stroke downward on the medial aspect of the knee and apply
pressure to force fluid into the lateral area.
 Tap the knee just behind the lateral margin of the patella with the
right hand.
 A fluid wave or bulge on the medial side between the patella and the
femur is considered a positive bulge sign consistent with an effusion.
The balloon sign ( for major effusions)
 Place the thumb and index finger of your right hand on each side of
the patella; with the left hand, compress the suprapatellar pouch
against the femur.
 Feel for fluid entering (or ballooning into) the spaces next to the
patella under your right thumb and index finger.
 When the knee joint contains a large effusion, suprapatellar
compression ejects fluid into the spaces adjacent to the patella.
 A palpable fluid wave signifies a positive “ balloon sign.”
 A returning fluid wave into the suprapatellar pouch confirms an
effusion.
Ballotting the patella
 To assess large effusions, you can also compress the suprapatellar
pouch and “ballotte” or push the patella sharply against the femur.
Watch for fluid returning to the suprapatellar pouch.
 Palpable fluid returning into the pouch further confirms the
presence of a large effusion.
 A palpable patellar click with compression may also occur, but yields
more false positives.
Thank you!