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Visual testing by eliciting fluctuation


The subject lies in the supine position with the leg extended.


The examiner strokes in a sweeping motion with the back of one hand over the lateral recessus and the suprapatellar pouch. This moves the fluid upwards and medially. In minor effusion, all the fluid is moved to the medial part of the suprapatellar pouch. The lateral recessus is then empty and can be seen
as a groove between patella and lateral femoral condyle. Sweeping with the back of the hand over the suprapatellar pouch, and downwards over the medial recessus will now transfer the fluid laterally where a small prominence appears
. This is the most delicate test for effusion in the knee joint, and will even demonstrate 2 or 3 ml of fluid.

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