Abstract
Introduction
Knee effusions occur due to traumatic and atraumatic causes. Clinical diagnosis currently
relies on several provocative techniques to demonstrate knee joint effusions. Portable
bedside ultrasonography (US) is becoming an adjunct to diagnosis of effusions. We
hypothesized that a US approach with a clinical joint cupping maneuver increases sensitivity
in identifying effusions as compared to US alone.
Methods
Using unembalmed cadaver knees, we injected fluid to create effusions up to 10 mL.
Each effusion volume was measured in a lateral transverse location with respect to
the patella. For each effusion we applied a joint cupping maneuver from an inferior
approach, and re-measured the effusion.
Results
With increased volume of saline infusion, the mean depth of effusion on ultrasound
imaging increased as well. Using a 2-mm cutoff, we visualized an effusion without
the joint cupping maneuver at 2.5 mL and with the joint cupping technique at 1 mL.
Mean effusion diameter increased on average 0.26 cm for the joint cupping maneuver
as compared to without the maneuver. The effusion depth was statistically different
at 2.5 and 7.5 mL (P < .05).
Conclusions
Utilizing a joint cupping technique in combination with US is a valuable tool in assessing
knee effusions, especially those of subclinical levels. Effusion measurements are
complicated by uneven distribution of effusion fluid. A clinical joint cupping maneuver
concentrates the fluid in one recess of the joint, increasing the likelihood of fluid
detection using US.
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Article Info
Publication History
Published online: September 16, 2013
Accepted:
August 9,
2013
Received:
July 25,
2013
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
