Assessment

1
Assessment Measurement of Swelling
2
Terminology

• Edema presence of excess fluid in interstitial
  space
• Effusion presence of excess fluid in synovial
  joint capsules
• Swelling can refer to either of the above

3
Assessment Measurement

• Testing Considerations
• Measure both extremities
• Measure at initial and each return visit
• Measure pre- and post- selected treatments
• Document testing procedure changes

4
Assessment Measurement

• Visual Inspection
• Location, location, location
• Color
• Temperature
• Pitting

5
Assessment Measurement

• Circumference Measurement
• Compare side to side
• Document in cm
• Difference gt 1-2 cm mild edema ( expert
  opinion)

6
Figure 8 of the Hand
Tape measure brought across ventral surface of
wrist from most distal aspect of ulnar styloid
process to most distal aspect of radial styloid
process. Tape is then brought diagonally across
dorsum of hand and over 5th MCP joint line,
brought over ventral surface of MCP jts, then
wrapped diagonaly across dorsum to meet start.
7
Measurement of Ankle Swelling ( Figure 8)

• Start tape measure midway between Anterior
  tibialis and lateral malleolus
• Go medial, distal to navicular tuberosity
• Pull across arch and proximal to base of 5th
  metatarsal
• Pull across Anterior tibialis at ankle distal to
  medial malleolus
• Pull across Achilles tendon distal to lateral
  malleolus back to start

8
Assessment MeasurementVolumeter
Minimal detectable change in hand volume 10
ml Boland 1996 10ml increase hand-wrist
volume with exercise Yamuchi 2008
9
Circumferential Measures at the Knee

• Mid-patella
• (1 cm above more reliable?)
• Kirwin et al
• 7 cm above
• 15 cm above
• Mid-calf

10
Stroke Test (aka Brush Test)

• Measurement for knee joint effusion
• Patient supine knee in full extension and
  relaxed
• Starting at the medial tibiofemoral joint line,
  stroke upward 2 or 3 times toward the
  suprapatellar pouch in an attempt to move the
  swelling within the joint capsule to the
  suprapatellar pouch
• Then stroke downward on the distal lateral thigh,
  just superior to the suprapatellar pouch, toward
  the lateral joint line
• Observe wave of fluid within seconds on the
  medial side of the knee

11
Effusion Grading Scale of the Knee Joint Based on
the Stroke Test

• Zero No wave produced on downstroke
• Trace Small wave on medial side with downstroke
• 1 Larger bulge on medial side with dowstroke
• 2 Effusion spontaneously returns to medial
  side after upstroke (no downstroke necessary)
• 3 So much fluid that it is not possible to
  move the effusion out of the medial aspect of the
  knee

12

• Interrater Reliability of a Clinical Scale to
  Assess Knee Joint Effusion
• Sturgill et al JOSPT Dec 2009
• Videos!