Bulge test
- It is also known as to brush, stroke or wipe test.
- This test is used for the assessing of swellings.
- Help of this test examiner is determine to type & amount of swelling.
- But must be take care to differentiate between swelling &synovial thickening during this test.
- With swelling knee is mostly rest between 15 ‘ to 25 ‘ of flexion.
Purpose of this test?
- This test is assesses minimal effusion of to knee.
- This test is also check swellings of to knee.
How do you perform of this test?
- Starting position of test is supine position.
- The examiner is put their hand below to joint line on to medial side of patella.
- Then examiner is do the stroking proximal toward to patient’s hip as far as the suprapatellar pouch for 2-3 times with to palm & fingers.
- With help of opposite hand the examiner is do the stroke down onto lateral side of to patella .
- A wave of fluid passes to the medial side of to joint & bulges just below to medial distal portion or border of to patella.
- This way of fluid is may be take up to 2 second to appear.
What is interpretation of this test?
- Into normally this knee is contain 1 to 7 ml of synovial fluid.
- But when swellings present it is shows as little as 4 to 8 ml of extra fluid of knee.
- In this situation this test is positive for swelling.
Grading of this test :
- This grade is describe by Strugill, et al.
| Grade | Test Result |
| zero | No wave produced on down stroke. |
| Trace | Small wave on medial side with down stroke. |
| 1+ | Large bulge on medial side with down stroke. |
| 2 + | Effusion spontaneously returns to medial side after upstroke, no need to down stroke. |
| 3 + | So much fluid that it is not possible to move effusion out of to medial aspect of to knee. |
