Video – Patellar Ballottement Test and Bulge Sign

Videos to help you sharpen your examination skills.
Educators are welcome to play these videos in class directly from this website.
Copyright © All rights reserved. Chiropractic Online CE ™ and Educom Continuing Education™

Video Playback Issues: If videos don’t play, it could be because you’ve remained on this web page for too long or you’ve lost your Internet connection. To resolve this issue, simply “refresh” or “reload” this web page.

No Sound?  If you’re playing a video and the sound isn’t working, it may be because the sound is off. When playing a video from a desktop computer, you will see a series of vertical bars at the bottom right corner of the video. When the vertical bars are blue, it means the sound is on (see image 1 below). If the vertical bars are grey, it means the sound is off (see image 2). To turn on the sound of a video, click on each vertical grey bar until all the bars become blue. On smaller devices such as a tablet or a phone, simply increase the volume of the device to be able to hear a video.

Select Exam Videos by Region

Select Exam Videos by Title Below

Patellar Ballottement Test and Bulge Sign

The Patellar Ballottement test is used when a large knee effusion is suspected. With the patient’s knee in full extension, compress the supra-patellar pouch distally to force the fluid below the patella. Now, press the patella into the trochlear groove and then release. In the presence of a large joint effusion, the patella will seem to float and rebound.

Smaller knee effusions can be assessed by checking to see if the Bulge Sign is present. With the patient’s knee extended, begin by stroking upward along the medial side of the patella several times to force the fluid to the lateral side. Now, apply a downward stroke on the lateral side and look for the bulge to appear on the medial side.

If a knee trauma causes the rapid development of effusion (usually within 2 to 4 hours), the effusion most likely consist of blood and is called haemarthrosis. This indicates serious injuries such as a ruptured anterior cruciate ligament or intraarticular fracture.  Haemarthrosis requires immediate aspiration.

If a knee trauma causes slow development of effusion (usually within 24 to 36 hours),  the effusion most likely consist of synovial fluid and is referred to synovial effusion. This indicates conditions such as a meniscal injury or ligamentous sprain.

A Chiropractic Online CE™ Production. Copyright © Educom Pty Ltd.

Please read the Disclaimer and Copyright statements at the bottom of this web page.

Disclaimer:  The Chiropractic Online CE  website (including the text, graphics and videos that appear on the are designed to offer users general health information for educational purposes only. The general health information furnished on this site is not intended to replace personal consultation with a qualified healthcare professional. You must always seek the advice of a healthcare professional for questions related to your disease, disease symptoms, and appropriate therapeutic treatments.

Copyright © Educom Pty Ltd: All material on this website (including the text, graphics, videos and downloadable files) are owned by or licensed to Educom Pty Ltd and is subject to copyright and other intellectual property rights under international conventions.