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.