Knee joint effusion test

Knee Joint Effusion Test (Bounce-Home Test)... 

The knee joint effusion test is performed by supporting the patient s heel in one hand and the calf in the other. The knee is semi-flexed. The hand under the calf is removed carefully and the knee allowed to extend in the same manner as the recurvatum tests. Failure of the knee to extend fully indicates increased joint fluid. Normally the knee should extend fully and end, with a slight "bounce back" at the end point. 

An 87-year-old woman received intra-articular betamethasone (Diprophos) 7 mg on three occasions for painful knee joints over 6 months. Six weeks after the last injection she developed diffuse pain and contractures in the legs, fatigue, nausea, abdominal pain, and weight loss of 6 kg. Both knee joints were tender but there was no effusion. Her serum sodium concentration was 123 mmol/1, serum osmolality 254 mosmol/kg, urine sodium 136 mmol/1, and urinary osmolality 373 mosmol/kg. The syndrome of inappropriate antidiuretic hormone secretion was diagnosed, but despite treatment she remained drowsy and hyponatremic. About a week later, she developed hypotension and symptoms of an acute abdomen. Further investigations showed that her basal cortisol concentration was low (36 nmol/1) but it increased to 481 nmol/1 after a short tetracosactide test, consistent with acute adrenal crisis. She recovered rapidly after treatment with oral hydrocortisone, but still required glucocorticoid substitution several months later. 

Clinical demonstration of a knee effusion depends on the amount of intra-articular fluid. Abundant joint effusions can be detected by the patellar tap test in which the examiner first compresses the suprapatellar recess with one hand to squeeze the fluid under the patella and then pushes the patella... 

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See also in sourсe #XX -- [ ]

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