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This first way is the patellar tap. It is to squeeze the fluid between the patella and the femur by pressing at the medial patella using a non-dominant hand. Then, using the dominant hand to press on the patella vertically. If the patella is ballotable, then patellar intra-articular effusion is present. Another way is the milking of the patella.
The patellar tap is a technique used in an examination of the knee to test for knee effusion or "water-on-the-knee". [1]With the examinee lying on their back, the examiner extends the knee and presses the area above the kneecap with the palm of one hand.
Knee effusion, informally known as water on the knee, occurs when excess synovial fluid accumulates in or around the knee joint. It has many common causes, including arthritis, injury to the ligaments or meniscus, or fluid collecting in the bursa, a condition known as prepatellar bursitis.
the suprapatellar bursa or recess between the anterior surface of the lower part of the femur and the deep surface of the quadriceps femoris. [2] It allows for movement of the quadriceps tendon over the distal end of the femur. In about 85% of individuals, this bursa communicates with the knee joint.
The approach to diagnosis depends on the joint involved. While aspiration of the joint is considered the gold standard of treatment, this can be difficult for joints such as the hip. Ultrasound may be used both to verify the existence of an effusion and to guide aspiration. [2]
Ballottement is a medical sign which indicates increased fluid in the suprapatellar pouch over the patella at the knee joint. To test ballottement the examiner would apply downward pressure towards the foot with one hand, while pushing the patella backwards against the femur with one finger of the opposite hand.
The patient is asked to actively contract the quadriceps muscle while the examiner's hand exerts pressure on the superior pole of the patella, so trying to prevent the proximal movement of the patella. While it can produce some discomfort even in normal people, the reproduction of the symptoms suggest pain of patellofemoral origin.
In human anatomy, a bursa is a small pouch filled with synovial fluid. Its purpose is to reduce friction between adjacent structures. The prepatellar bursa is one of several bursae of the knee joint, and is located between the patella and the skin. [8] Prepatellar bursitis is an inflammation of this bursa. Bursae are readily inflamed when ...