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=== Search strategy ===
<div class="editorbox">
'''Original Editor '''­ [[User:Amir Adam|Amir Adam]] as part of the [[Vrije Universiteit Brussel Evidence-based Practice Project|Vrije Universiteit Brussel's Evidence-based Practice project]]
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<br>Web of knowledge, Pubmed, PEDro, Google Scholar, Google Books and the medical library of the VUB were consulted to find related, evidence-based articles about the sweep test. Using the search terms&nbsp;: ‘’sweep test’’, ‘’knee hydrops’’, ‘’knee effusion’’, ‘’effusion wave’’, ‘’bulge test’’, ’’sweep test’’, ‘’patella(r) sweep’’, ‘’brush test’’, ‘’wipe test’’, ‘’edema’’ or ‘’moderate stroke test’’ were used. These search terms were also used in combination using Boolean operators: ‘’AND’’ or/and ‘’OR’’. Only one result contained information concerning validity and reliability of the test.<br>Searching in Google Books, there was found one clue in [1] describing the test after which he referred to ‘’Hoppenfield 1986’’. After many searches nothing was found so the book[1] most likely had a typing error in it, indicating that it should be ‘’Hoppenfeld’’ &nbsp;as in [http://www.scoliosisassociates.com/subject.php?pn=practice1006 Stanley Hoppenfeld], who publiced an article in 1979 called&nbsp;: ’’PHYSICAL-EXAMINATION OF THE KNEE-JOINT BY COMPLAINT’’[2]. Sadly enough no e-version is accessible.<br>Through comments of a YouTube clip (which is part of the article) showing the sweep test, there was found a recent(2009) article[3] measuring the inter-rater reliability of the ‘’5-point effusion grading scale of the knee joint based on the sweep test’’.
==  Definition/description  ==


<br>
The sweep test is also known as knee hydrops test, knee effusion test, effusion wave test, bulge test, patella sweep test, brush test It is used to assess for joint effusion- presence of increased intra-articular fluid in the knee area.<ref>David J. Mathison, MD*Þ and Stephen J. Teach, MD, MPH*Þ Pediatric Emergency Care Issue: Volume 25(11), November 2009, pp 773-786 [level of evidence: B]</ref><br>The sweep test is often paired with the&nbsp;[http://www.physio-pedia.com/index.php?title=Ballottement_patella_test&action=edit&redlink=1 ballottement patella test]&nbsp;(in which the examiner strokes the proximal hand on the thigh towards the knee and taps on the patella with the index finger of his distal hand) and the [http://www.physio-pedia.com/index.php?title=Fluctuation_test&action=edit&redlink=1 fluctuation test]&nbsp;(in which the examiner is placing his fingers of one hand near the apex and with the other hand near the base of the patella, while the fingers are used to alternate press and feel the fluid displacing).  
 
=== <br>Definition/description  ===
 
The sweep test (also: , ‘’[http://www.physio-pedia.com/Sweep_test knee hydrops test]’’, ‘’[http://www.physio-pedia.com/Sweep_test knee effusion test]’’, ‘’[http://www.physio-pedia.com/Sweep_test effusion wave test]’’, ‘’[http://www.physio-pedia.com/Sweep_test bulge test]’’, ’’[http://www.physio-pedia.com/Sweep_test sweep test]’’, ‘’[http://www.physio-pedia.com/Sweep_test patella(r) sweep test]’’, ‘’[http://www.physio-pedia.com/Sweep_test brush test]’’, ‘’[http://www.physio-pedia.com/Sweep_test wipe test]’’ or ‘’[http://www.physio-pedia.com/Sweep_test moderate stroke test]’’) is used to assess for joint effusion in the knee area. Joint effusion is the presence of increased intra-articular fluid[4].<br>The sweep test is used worldwide and often paired with the&nbsp;[http://www.physio-pedia.com/index.php?title=Ballottement_patella_test&action=edit&redlink=1 ballottement patella test]&nbsp;(also: [http://www.physio-pedia.com/index.php?title=Ballottement_patella_test&action=edit&redlink=1 patellar tap test]; in which the examinator strokes the proximal hand on the thigh towards the knee and taps on the patella with the index finger of his distal hand) and the [http://www.physio-pedia.com/index.php?title=Fluctuation_test&action=edit&redlink=1 fluctuation test]&nbsp;(in which the examinator is placing his fingers of one hand near the apex and with the other hand near the basis of the patella, while the fingers are used to alternatingly press and feel the fluid displacing).  
 
=== <br>Clinically relevant anatomy  ===
 
<br>Click [http://www.sportsinjuryclinic.net/cybertherapist/kneeanatomy.php here]&nbsp;to get more information of anatomy of the knee area.<br>
 
=== <br>Purpose  ===
 
<br>To test for minimal joint effusion. Notice that even a ‘’healthy’’ joint has a ‘’normal’’ amount of fluid in the joint capsule, but ‘’minimal’’ suggests there is an excess of fluid which cannot be noticed on sight but can be tested with the sweep test.
 
=== <br>Technique  ===
 
<br>The patient lying in supine position and has the knee in full extension and relaxed. The examiner puts his hand beneath the medial tibiofemoral joint line. Then he strokes his hand(or hands) upwards and towards the suprapatellar bursa for 2 à 3 times in a sweeping motion in an attempt moving the effusion from the inside of the joint capsule to the suprapatellar pouch.
 
<br>
 
http://i43.tinypic.com/23j4pjr.jpg<br> <br>The examiner then strokes downwards on the lateral aspect of the knee (thigh), just superior to the suprapattelar bursa towards the lateral joint line. If the test tests positive you’ll detect a small wave or bulge on the medial aspect of the knee, just inferior to the patella within a few seconds.
 
<br>
 
=== Validity, Reliability  ===


<br>Research by Fritz et al. has shown that the inter-rater reliability of both tests was rather poor: fluctuation test, қ = 0.37, patellar tap test, қ = 0.21 (Cohen's kappa coefficient was used). In contrast to the sweep test which scores very highly in inter-rater reliability (қ = 0.75)[3] observed as a proportion of the maximum possible kappa score, with a percent agreement of 73%. Fifty-four of 75 pairs of tests had perfect agreement. Only with 5 pairs there was disagreement of 2 grades, and in that marge, there was no disagreement of greater than 2 grades ever.
== Clinically relevant anatomy  ==


<br>  
<br>Click [[Knee|here]]&nbsp;to get more information of anatomy of the knee.<br>  


=== Rating ===
==  Purpose  ==


<br>When rating is deemed necessary ,the test can be measured in quantity on a 5-point grading scale. A 0 (zero) grade is given when there is no fluid-wave while performing a downward stroke. If the downward stroke produces a small bulge on the medial aspect of the knee, a trace is given; a larger bulge is scored with a 1+ grade. If the medial fluid returns to its position without performing a downward sweep, a grade of 2+ is given. And if there is such an excess of fluid that makes it impossible to stroke the medial fluid away, a 3+ grade is given.  
<br>To test for minimal joint [[Effusion tests|effusion]]. Note that even a healthy joint has a normal amount of fluid in the joint capsule, but ‘’minimal’’ suggests there is an excess of fluid which cannot be noticed on sight but can be tested with the sweep test.  


=== <br>Video ===
== Technique ==
# The patient lying in supine position with the knee in full extension and relaxed, the examiner puts his hand beneath the medial tibiofemoral joint line. 
# Then he strokes his hand upwards and towards the suprapatellar bursa 2 -3 times in a sweeping motion in an attempt to move the effusion from the inside of the joint capsule to the suprapatellar pouch. 
# The examiner then strokes downwards on the lateral aspect of the knee just superior to the supra-patellar bursa towards the lateral joint line. If the test tests positive you’ll detect a small wave or bulge on the medial aspect of the knee, just inferior to the patella within a few seconds.


http://www.youtube.com/watch?v=LsgutijmX7U&amp;feature=relmfu<br>
{{#ev:youtube|LsgutijmX7U}}
== Validity, Reliability  ==


=== <br>Key research  ===
<br>Research by Fritz et al.<ref>Fritz JM, Delitto A, Erhard RE, Roman M. An examination of the selective tissue tension scheme, with evidence for the concept of a capsular pattern of the knee. Phys Ther. 1998;78:1046-1056; discussion 1057-1061. http://ptjournal.apta.org/content/78/10/1046.full.pdf+html [level of evidence: B]</ref> has shown that the inter-rater reliability of both tests was rather poor: fluctuation test, қ = 0.37, patellar tap test, қ = 0.21 (Cohen's kappa coefficient was used). In contrast to the sweep test which scores very highly in inter-rater reliability (қ = 0.75)<ref>Interrater Reliability of a Clinical Scale to Assess Knee Joint Effusion Patterson Sturgill et al.; Journal of Orthopaedic Sports Physical Therapy 39 (2009) 845-849</ref>observed as a proportion of the maximum possible kappa score, with a percent agreement of 73%. Fifty-four of 75 pairs of tests had perfect agreement. Only with 5 pairs there was disagreement of 2 grades, and in that marge, there was no disagreement of greater than 2 grades ever.
 
<br>add appropriate key research here
 
=== Resources  ===
 
<br>add appropriate resources here
 
=== Clinical Bottem Line  ===
 
<br>add appropriate text here


<br>  
<br>  


=== Recent related research (from Pubmed) ===
== Rating ==
 
<br>add appropriate recent related research here


=== References ===
<br>It can be measured in quantity on a 5-point grading scale.
* 0 - no fluid-wave while performing a downward stroke.
* Trace - a small bulge on the medial aspect of the knee
* 1+  - a larger bulge
* 2+  - medial fluid returns to its position without performing a downward sweep
* 3+  - excess of fluid that makes it impossible to stroke the medial fluid away


<br>[1] Clinical Case Studies in Physiotherapy: A Guide for Students and Graduates (Physiotherapy Pocketbooks)<br>Lauren Jean Guthrie (Editor) <br>Publisher: Churchill Livingstone<br>ISBN: 0443069166 DDC: 615.82 Edition: Paperback; 2008-11-20<br>[2] Hoppenfeld, S.: Physical Examination of the Knee Joint by Complaint, Orthopaedic Clinics of North America, Vol. 10, No. 1, January 1979 [LEVEL OF EVIDENCE: NONE]<br>[3] Interrater Reliability of a Clinical Scale to Assess Knee Joint Effusion Patterson Sturgill et al.; Journal of Orthopaedic Sports Physical Therapy 39 (2009) 845-849<br>http://www.jospt.org/members/getfile.asp?id=4612 [LEVEL OF EVIDENCE&nbsp;: B]
== References  ==


[4] Approach to Knee Effusions<br>David J. Mathison, MD*Þ and Stephen J. Teach, MD, MPH*Þ<br>Pediatric Emergency Care<br>Issue: Volume 25(11), November 2009, pp 773-786 Copyright: © 2009 Lippincott Williams &amp; Wilkins, Inc. [level of evidence: B]<br>Sports Injuries<br>Michael Hutson, Cathy Speed, <br>Publisher: Oxford University Press, USA<br>ISBN: 0199533903 DDC: 617 Edition: Hardcover; 2010-07-01<br>Examination of musculoskeletal injuries<br>Sandra J. Shultz, Peggy A. Houglum, David H. Perrin<br>Publisher: Champaign, IL&nbsp;: Human Kinetics, c2005.<br>ISBN: 0736051384 Edition: (hard cover)<br>Fritz JM, Delitto A, Erhard RE, Roman M. An examination of the selective tissue tension scheme, with evidence for the concept of a capsular pattern of the knee. Phys Ther. 1998;78:1046-1056; discussion 1057-1061. http://ptjournal.apta.org/content/78/10/1046.full.pdf+html [level of evidence: B]<br>Acute Knee Effusions: A Systematic Approach to Diagnosis<br>MICHAEL W. JOHNSON, MAJ, MC, USA, Madigan Army Medical Center, Tacoma, Washington<br>Am Fam Physician. 2000,Apr,15;61(8):2391-2400. <br>http://www.aafp.org/afp/2000/0415/p2391.html [level of evidence: B]<br>Sports Injuries<br>Michael Hutson, Cathy Speed, <br>Publisher: Oxford University Press, USA<br>ISBN: 0199533903 DDC: 617 Edition: Hardcover; 2010-07-01<br>Examination of musculoskeletal injuries<br>Sandra J. Shultz, Peggy A. Houglum, David H. Perrin<br>Publisher: Champaign, IL&nbsp;: Human Kinetics, c2005.<br>ISBN: 0736051384 Edition: (hard cover)<br>http://www.sportsinjuryclinic.net/cybertherapist/kneeanatomy.php
[[Category:Vrije_Universiteit_Brussel_Project]]
[[Category:Assessment]]
[[Category:Musculoskeletal/Orthopaedics|Orthopaedics]]
[[Category:Knee]]  
[[Category:Special_Tests]]
[[Category:Knee - Assessment and Examination]]
<references />
[[Category:Sports Medicine]]
[[Category:Athlete Assessment]]
[[Category:Knee - Special Tests]]

Latest revision as of 09:00, 12 June 2021

Original Editor ­ Amir Adam as part of the Vrije Universiteit Brussel's Evidence-based Practice project

Top Contributors - Amir Adam, Simisola Ajeyalemi, Kim Jackson, Tony Lowe, Rucha Gadgil, Wanda van Niekerk, Admin, Daphne Jackson, Kai A. Sigel and WikiSysop

Definition/description[edit | edit source]

The sweep test is also known as knee hydrops test, knee effusion test, effusion wave test, bulge test, patella sweep test, brush test It is used to assess for joint effusion- presence of increased intra-articular fluid in the knee area.[1]
The sweep test is often paired with the ballottement patella test (in which the examiner strokes the proximal hand on the thigh towards the knee and taps on the patella with the index finger of his distal hand) and the fluctuation test (in which the examiner is placing his fingers of one hand near the apex and with the other hand near the base of the patella, while the fingers are used to alternate press and feel the fluid displacing).

Clinically relevant anatomy[edit | edit source]


Click here to get more information of anatomy of the knee.

Purpose[edit | edit source]


To test for minimal joint effusion. Note that even a healthy joint has a normal amount of fluid in the joint capsule, but ‘’minimal’’ suggests there is an excess of fluid which cannot be noticed on sight but can be tested with the sweep test.

Technique[edit | edit source]

  1. The patient lying in supine position with the knee in full extension and relaxed, the examiner puts his hand beneath the medial tibiofemoral joint line.
  2. Then he strokes his hand upwards and towards the suprapatellar bursa 2 -3 times in a sweeping motion in an attempt to move the effusion from the inside of the joint capsule to the suprapatellar pouch.
  3. The examiner then strokes downwards on the lateral aspect of the knee just superior to the supra-patellar bursa towards the lateral joint line. If the test tests positive you’ll detect a small wave or bulge on the medial aspect of the knee, just inferior to the patella within a few seconds.

Validity, Reliability[edit | edit source]


Research by Fritz et al.[2] has shown that the inter-rater reliability of both tests was rather poor: fluctuation test, қ = 0.37, patellar tap test, қ = 0.21 (Cohen's kappa coefficient was used). In contrast to the sweep test which scores very highly in inter-rater reliability (қ = 0.75)[3]observed as a proportion of the maximum possible kappa score, with a percent agreement of 73%. Fifty-four of 75 pairs of tests had perfect agreement. Only with 5 pairs there was disagreement of 2 grades, and in that marge, there was no disagreement of greater than 2 grades ever.


Rating[edit | edit source]


It can be measured in quantity on a 5-point grading scale.

  • 0 - no fluid-wave while performing a downward stroke.
  • Trace - a small bulge on the medial aspect of the knee
  • 1+ - a larger bulge
  • 2+ - medial fluid returns to its position without performing a downward sweep
  • 3+ - excess of fluid that makes it impossible to stroke the medial fluid away

References[edit | edit source]

  1. ↑ David J. Mathison, MD*Þ and Stephen J. Teach, MD, MPH*Þ Pediatric Emergency Care Issue: Volume 25(11), November 2009, pp 773-786 [level of evidence: B]
  2. ↑ Fritz JM, Delitto A, Erhard RE, Roman M. An examination of the selective tissue tension scheme, with evidence for the concept of a capsular pattern of the knee. Phys Ther. 1998;78:1046-1056; discussion 1057-1061. http://ptjournal.apta.org/content/78/10/1046.full.pdf+html [level of evidence: B]
  3. ↑ Interrater Reliability of a Clinical Scale to Assess Knee Joint Effusion Patterson Sturgill et al.; Journal of Orthopaedic Sports Physical Therapy 39 (2009) 845-849
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