Note presence and symmetry of swelling; any discolouration; skin lesions (eg old surgical scars); muscle wasting
Temperature (check symmetry).
Palpate knee joint structures:
a) Patellofemoral joint
b) Medial collateral ligament
c) Lateral collateral ligament
d) Medial joint line – do with knee flexed at 30º
e) Lateral joint line
f) Posterior aspect
Presence of effusion:
First signs are bulging at side of patellar ligament next suprapatellar pouch becomes distended.
Patellar tap test:
Squeeze excess fluid from the suprapatellar pouch with thumb and forefinger by sliding had down from 18cm above joint. Then place tips of thumb and 3 fingers of other had on patella and ‘jerk’ it quickly downwards. If get click effusion is present.
Fluid displacement test:
For small effusions. Squeeze excess fluid from suprapatellar pouch as for patellar tap test. Stroke medial side of joint to squeeze excess fluid to lateral side of joint. Then do same to lateral side of joint observe for effusion on medial side.