Sweep test


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Definition/description

The sweep test (also: , ‘’knee hydrops test’’, ‘’knee effusion test’’, ‘’effusion wave test’’, ‘’bulge test’’, ’’sweep test’’, ‘’patella(r) sweep test’’, ‘’brush test’’, ‘’wipe test’’ or ‘’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].
The sweep test is used worldwide and often paired with the ballottement patella test (also: 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 fluctuation test (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).

Clinically relevant anatomy

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

Purpose

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.

Technique

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.

http://i43.tinypic.com/23j4pjr.jpg

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.

Validity, Reliability

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.

Rating

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.

Key research

[2]

Resources

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Clinical Bottem Line

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Recent Related Research (from Pubmed)


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References

[1] Clinical Case Studies in Physiotherapy: A Guide for Students and Graduates (Physiotherapy Pocketbooks)
Lauren Jean Guthrie (Editor)
Publisher: Churchill Livingstone
ISBN 0443069166 DDC: 615.82 Edition: Paperback; 2008-11-20

[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]

[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
http://www.jospt.org/members/getfile.asp?id=4612 [LEVEL OF EVIDENCE : B]

[4] Approach to Knee Effusions
David J. Mathison, MD*Þ and Stephen J. Teach, MD, MPH*Þ
Pediatric Emergency Care
Issue: Volume 25(11), November 2009, pp 773-786 Copyright: © 2009 Lippincott Williams & Wilkins, Inc. [level of evidence: B]

Sports Injuries
Michael Hutson, Cathy Speed,
Publisher: Oxford University Press, USA
ISBN 0199533903 DDC: 617 Edition: Hardcover; 2010-07-01

Examination of musculoskeletal injuries
Sandra J. Shultz, Peggy A. Houglum, David H. Perrin
Publisher: Champaign, IL : Human Kinetics, c2005.
ISBN 0736051384 Edition: (hard cover)

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]

Acute Knee Effusions: A Systematic Approach to Diagnosis
MICHAEL W. JOHNSON, MAJ, MC, USA, Madigan Army Medical Center, Tacoma, Washington
Am Fam Physician. 2000,Apr,15;61(8):2391-2400.
http://www.aafp.org/afp/2000/0415/p2391.html [level of evidence: B]

Sports Injuries
Michael Hutson, Cathy Speed,
Publisher: Oxford University Press, USA
ISBN 0199533903 DDC: 617 Edition: Hardcover; 2010-07-01

Examination of musculoskeletal injuries
Sandra J. Shultz, Peggy A. Houglum, David H. Perrin
Publisher: Champaign, IL : Human Kinetics, c2005.
ISBN 0736051384 Edition: (hard cover)
http://www.sportsinjuryclinic.net/cybertherapist/kneeanatomy.php