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Knee Bulge Sign

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1. Knee Bulge Sign

Knee Bulge Sign Knee Bulge Sign Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Knee Bulge Sign Knee Bulge Sign Aka: Knee Bulge Sign (...) II. Indication Evaluation for small effusion III. Technique Examiner uses ball of hand over medial knee Milk fluid distally from suprapatellar pouch Repeat several times Press behind lateral margin Swelling reappears in effusion IV. Interpretation: Positive test implies effusion may be detected at 10-15 cc of fluid Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Knee Bulge Sign." Click on the image (or right click) to open

2018 FP Notebook

2. Knee Bulge Sign

Knee Bulge Sign Knee Bulge Sign Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Knee Bulge Sign Knee Bulge Sign Aka: Knee Bulge Sign (...) II. Indication Evaluation for small effusion III. Technique Examiner uses ball of hand over medial knee Milk fluid distally from suprapatellar pouch Repeat several times Press behind lateral margin Swelling reappears in effusion IV. Interpretation: Positive test implies effusion may be detected at 10-15 cc of fluid Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Knee Bulge Sign." Click on the image (or right click) to open

2015 FP Notebook

3. Diagnostic Performance of Knee Physical Exam and Participant-Reported Symptoms for MRI-Detected Effusion-Synovitis among Participants With Early or Late Stage Knee Osteoarthritis: Data from the Osteoarthritis Initiative. (PubMed)

with or at risk for knee OA. Two samples with MRI readings were available: 344 knees with early OA (312 participants) and 216 with late-stage OA (186 participants). Trained examiners performed bulge sign (BS) and patellar tap (PT) exams, and participants reported on knee swelling and pain with leg straightening. Effusion-synovitis on 3T non-contrast MRI was scored using the MRI Osteoarthritis Knee Score (MOAKS). Diagnostic performance of physical exam findings and symptoms was estimated with bootstrapped (...) Diagnostic Performance of Knee Physical Exam and Participant-Reported Symptoms for MRI-Detected Effusion-Synovitis among Participants With Early or Late Stage Knee Osteoarthritis: Data from the Osteoarthritis Initiative. Evaluate the diagnostic performance of knee physical exam findings and participant-reported symptoms for MRI-detected effusion-synovitis (ES) among knees with early and late-stage osteoarthritis (OA).The Osteoarthritis Initiative (OAI) is a longitudinal study of participants

2018 Osteoarthritis and Cartilage

4. A Study Evaluating the Safety and Efficacy of a Second Course of TPX-100 in Subjects Who Previously Received TPX-100 for Patellar Osteoarthritis Involving Both Knees

with downstroke 1+ = Larger bulge on medial side with downstroke 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 screening Last viscosupplementation (e.g. Synvisc® or similar hyaluronic acid product) injected into either knee < 3 months before screening Last intra-articular knee injection of corticosteroids < 2 months before screening Use of any steroids (except (...) inhaled corticosteroids for respiratory problems) during the previous month before screening Known hypersensitivity to TPX-100 Known hypersensitivity to acetaminophen or hydrocodone History of arthroscopy in either knee in the last 3 months before screening History of septic arthritis, gout or pseudo-gout, of either knee in previous year before screening Clinical signs of acute meniscal tear (locking, new acute mechanical symptoms consistent with meniscal tear) Patellar chondrocalcinosis on X-Ray Skin

2016 Clinical Trials

5. Interobserver and Intraobserver Reliability of Clinical Assessments in Knee Osteoarthritis. (PubMed)

to determine interobserver and intraobserver levels of agreement.Using Landis and Koch criteria, interobserver κ scores were moderate for patellofemoral joint (κ = 0.53) and anserine tenderness (κ = 0.48); good for bony enlargement (κ = 0.66), quadriceps wasting (κ = 0.78), crepitus (κ = 0.78), medial tibiofemoral joint tenderness (κ = 0.76), and effusion assessed by ballottement (κ = 0.73) and bulge sign (κω = 0.78); and excellent for lateral tibiofemoral joint tenderness (κ = 1.00), flexion (ICC = 0.97 (...) ), and extension (ICC = 0.87) ROM. Intraobserver κ scores were moderate for lateral tibiofemoral joint tenderness (κ = 0.60); good for crepitus (κ = 0.78), effusion assessed by ballottement test (κ = 0.77), patellofemoral joint (κ = 0.66), medial tibiofemoral joint (κ = 0.64), and anserine tenderness (κ = 0.73); and excellent for effusion assessed by bulge sign (κω = 0.83), bony enlargement (κ = 0.98), quadriceps wasting (κ = 0.83), flexion (ICC = 0.99), and extension (ICC = 0.96) ROM.Among individuals

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2016 Journal of Rheumatology

6. Non-Inferiority Study Comparing 3 Weekly Injections of SUPARTZ® vs 3 Weekly Injections of Euflexxa® for Knee OA

weeks of the screening visit or during study participation. History of surgical treatment to the study knee or arthroscopic intervention within three months prior to the screening visit. Clinically apparent tense effusion of the study knee on examination determined by either a positive bulge sign or positive ballottement of the patella (patellar tap). Subjects with clinically diagnosed symptomatic OA of the hip. Contacts and Locations Go to Information from the National Library of Medicine To learn (...) Non-Inferiority Study Comparing 3 Weekly Injections of SUPARTZ® vs 3 Weekly Injections of Euflexxa® for Knee OA Non-Inferiority Study Comparing 3 Weekly Injections of SUPARTZ® vs 3 Weekly Injections of Euflexxa® for Knee OA - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved

2014 Clinical Trials

7. A Study Evaluating the Safety and Efficacy of Intra-articular Injections of TPX-100 in Subjects With Mild to Moderate Patello-Femoral Osteoarthritis Involving Both Knees

other autoimmune or infectious cause for arthritis Knee effusion >2+ on the following clinical scale: Zero = No wave produced on downstroke Trace = Small wave on medial side with downstroke 1+ = Larger bulge on medial side with downstroke 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 Last viscosupplementation (e.g. Synvisc® or similar hyaluronic acid (...) in previous year before screening Clinical signs of acute meniscal tear (locking, new acute mechanical symptoms consistent with meniscal tear) Patellar chondrocalcinosis on X-Ray Skin problem, rash or hypersensitivity, affecting either knee at the injection site Bleeding problem, platelet or coagulation deficiency contraindicating, in the doctor's opinion, any intra-articular injection Active systemic infection Current treatment or treatment within the previous 2 years prior to the Screening Visit for any

2013 Clinical Trials

8. Comparative Study of Safety and Efficacy of Two Hyaluronic Acids for the Treatment of Knee Osteoarthritis

osteoarthritis of the study knee that fulfil the ACR(American College of Rheumatology) criteria Radiographic evidence of osteoarthritis in the study knee (Kellgren Lawrence radiographic score is 2 or 3) Exclusion Criteria: Clinically apparent tense effusion of the study knee on examination determined by either a positive bulge sign or positive ballottement of the patella Kellgren-Lawrence radiographic score 0, 1 or 4 in the study knee Symptomatic osteoarthritis of the contralateral knee or of either hip (...) scoring for pain assessment. Physical examination of the knees and vital signs will be performed (this examination will be repeated at end). Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial) Actual Enrollment : 350 participants Allocation: Randomized Intervention Model: Parallel Assignment Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor) Primary Purpose: Treatment Official Title: Comparative Study of Safety and Efficacy

2011 Clinical Trials

9. Overview of sport-related injuries

, or excessive rotational forces about the knee. Boden BP, Dean GS, Feagin JA, et al. Mechanisms of anterior cruciate ligament injury. Orthopedics. 2000;23:573-578. http://www.ncbi.nlm.nih.gov/pubmed/10875418?tool=bestpractice.com Ettlinger CF, Johnson RJ, Shealy JE. A method to help reduce the risk of serious knee sprains incurred in alpine skiing. Am J Sports Med. 1995;23:531-537. http://www.ncbi.nlm.nih.gov/pubmed/8526266?tool=bestpractice.com Presenting signs and symptoms include an audible "pop", rapid (...) =bestpractice.com Popliteal cyst, also known as Baker's cyst, is the result of an accumulation of synovial fluid outside the joint that forms behind the knee. This occurs via increased intrasynovial pressure and causes the synovial capsule to bulge at an area where there is a lack of external anatomical support. Labropoulos N, Shifrin DA, Paxinos O. New insights into the development of popliteal cysts. Br J Surg. 2004;91:1313-1318. http://www.ncbi.nlm.nih.gov/pubmed/15376180?tool=bestpractice.com The most

2018 BMJ Best Practice

10. A Controlled Study of an Herbal Topical Patch in Treating Osteoarthritis (OA) of the Knee

body region Signs of clinically important active inflammation of the study knee joint including redness, warmth, and/or a large, bulging effusion with the loss of normal contour at the screening and/or baseline visits Other criteria that - in the opinion of the investigator - may jeopardize the safety of the subject or the study results. Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research (...) A Controlled Study of an Herbal Topical Patch in Treating Osteoarthritis (OA) of the Knee A Controlled Study of an Herbal Topical Patch in Treating Osteoarthritis (OA) of the Knee - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more

2010 Clinical Trials

11. Treatment Of Knee Osteoarthritis With Intra-Articular Infliximab

Measures : Change in Cellular Infiltrates From Day 0 to Day 28 [ Time Frame: Day 0 to Day 28 ] Cellular infiltration scored 0 to 3 Secondary Outcome Measures : Change in Joint Effusions From Day 0 to Day 56 Target Knee [ Time Frame: Change from Day 0 to Day 56 ] Outcome calculated based on Physician observation of joint swelling from 0-3. A score of 0 = no effusion,1 = positive "bulge," 2 = moderate effusion, 3 = tense effusion. The outcome represents the change in means between the two time points (...) : Adults ≥ age 35 but ≤ age 85. Painful knees for 3-60 months. VAS joint pain score greater than 30 mm (scale 0-100) Knee radiograph showing minimal to moderate change (early OA). No NSAID therapy for at least one week. Have the capacity to understand and sign an informed consent form. Gender: Male or female Women must be postmenopausal (no menstrual period for a minimum of 1 year) or surgically sterilized and have a negative serum pregnancy test on entry in the study. Men must agree to use adequate

2010 Clinical Trials

12. CRACKCast E171 – Pediatric Cardiac Disorders

of a congenital heart defect should be considered in an infant who presents with central cyanosis that does not respond to 100% supplemental oxygen (hyperoxia challenge). Neonates with ductal-dependent cardiac lesions typically present within the first 2 to 3 weeks of life with either acute cyanosis or shock. Initiation of a prostaglandin E1 (PGE1) infusion (0.05 to μg/kg/min) will be lifesaving in these neonates. Treatment of a hypoxic tet spell first includes the placement of an infant in the knee-to-chest (...) and intravenous immune globulin (IVIG) infusion can prevent the formation of coronary aneurysms. Acute bacterial endocarditis should always be considered in a child with a known congenital heart defect or an acquired cardiac defect who presents with fever of unknown origin, acute neurologic deficits, new-onset microscopic hematuria, myalgias, splenomegaly, petechiae, or other signs of systemic embolization. Oxygen, positive pressure ventilation (noninvasive or invasive), diuretics, and possibly inotropes

2018 CandiEM

13. Barricaid® prosthesis for partial annulus replacement

intervertebral space to close the opening created during discectomy. Placement of the mesh takes an additional 5 to 15 minutes just prior to wound closure in a surgery that takes approximately 2 hours. 1-4 Figure 1: Barricaid implant 3 According to the manufacturer, patients who would most benefit from a Barricaid mesh implant have the following characteristics: primary, mediolaterial disc herniation at the L3 to S1 level (side-to-side bulging of the disc between the third lumbar and first sacral vertebrae (...) Technology use Therapeutic Barricaid® prosthesis for partial annulus replacement: March 2015 3 Patient Indication and Setting Disease description and associated mortality and morbidity The vertebral discs between adjacent vertebrae are made up of a soft inner core (the nucleus pulposus) surrounded by a tough circular exterior (the annulus fibrosus) that prevents the nucleus from herniating (bulging out). Sometimes called a slipped or ruptured disc, a herniated disc most often occurs in the lower back

2018 COAG Health Council - Horizon Scanning Technology Briefs

14. Exam Series: Guide to the Back Exam

>50, history of IV drug use, history of cancer, and back pain that has not improved despite treatment are other red flags. Approach to the Physical Examination – “Look, Feel, Move” Begin with a general assessment of a patient and their vital signs. A screening cardiovascular, respiratory, and abdominal examination is warranted to rule out extrinsic life-threatening etiologies of back pain. A pulsatile abdominal mass felt with palpation or visible on ultrasound is concerning for a AAA. Flank pain (...) signs of infection. Palpation : Palpate the paraspinal muscles for atrophy, tension, and pain. Palpate the spinal column for any step deformities and point tenderness. Pain with percussion is a sign of infection or fracture. Bony landmarks include: C7: bony prominence at the base of the neck T3: level at the spine of the scapula T7: level at the angle of the scapula L3-L4: iliac crests S2: iliac spine Range of Motion : Assess for flexion, extension, lateral flexion (ear to shoulder) and rotation

2018 CandiEM

16. CRACKCast E180 – Labor & Delivery

● Progression ● Bloody show / mucus ● Plug expelled ● Cervical dilation and/or effacement (first stage of labour) When in doubt, ask for obstetric assessment; wait and see; and get fetal/electrical monitoring! 2) Describe the 4 phases of labor Phase 1 Phase 2 Phase 3 Phase 4 Latent phase Active phase (cervix >3cm) ● Where we determine what the presenting part is Fully dilated cervix Urge to push Usually lasts < 1 hr Get ready for delivery! Signs of placental separation include the following: the uterus (...) , early, and late. These terms refer to the timing of the deceleration relative to the uterine contraction. The clinical implications: Vary based on each issue. g. ominous signs mandating rapid delivery: Bradycardia Late decels Sinusoidal tracing Persistent variable decels More on this in the Wisecracks. 5) What are causes of inadequate contractions or “labour arrest” Dystocia, or abnormal labor progression, accounts for one-third of all cesarean sections and half of primary cesarean sections. We

2018 CandiEM

17. CRACKCast E176 – Pediatric Musculoskeletal Disorders

of the extended elbow, oblique view, and lateral view of the flexed elbow. Features: Posterior fat pad sign (indicates intra-articular injury; does not mean there must be a fracture – although ~90% of the time there is) on the lateral view 1. Protruding or bulging anterior fat pad No bisection of the anterior ⅓ of the capitellum with the ANTERIOR HUMERAL LINE on the lateral view Broken “hour-glass” or deformed “figure of 8” on the lateral view LACK of the radiocapitellar line bisecting the capitellum (...) : ● Antalgic gait, internal rotation is lost, abduction and flexion of the hip increase, thigh and gluteal muscle atrophy is more pronounced, and leg-length discrepancy develops. Drehmann’s sign can be elicited during passive flexion of the affected hip when the patient is supine; as flexion is increased from an extended position, the thigh abducts and rotates externally. ● Insidious and stuttering onset of limp ● Gradual pain – anywhere (groin, butt, knee, thigh) ○ Worse with activity better with rest

2018 CandiEM

18. CRACKCast E071 – Ophthalmology Part A

bulges forward–>***obstructs the trabecular meshwork*** decreases flow Second mechanism occurs without pupillary block: Flat iris folds and bunches over the angle Symptoms: Sudden severe eye pain, blurred vision, headache, N/V, abd. pain Halo around lights Signs: Hazy cornea, mid-dilated pupil Conjunctival injection, steamy cornea, dec. VA, inc. IOP Treatment: Decrease production of Aqueous Humour- Timolol 0.5% 1 drop, then repeat in 30 minutes – Apraclonidine 1% 1 drop once – Acetazolamide 500 mg PO (...) keratitis? Radiation burns Ultraviolet keratitis (tanning booths, sunlamps, high altitude, welder’s arc) Latent period of 6-10 hrs then: Foreign body sensation, tearing, intense pain photophobia, blepharospasm Signs Decreased VA, conjunctival injection Treatment Cycloplegic Topical broad spectrum abx (weak evidence for this) PO analgesics Symptoms should resolve in 24 hrs 3) What is ophthalmia neonatorum? In which time-frame are each bacteria expected to be causative? What is the treatment? Ophthalmia

2017 CandiEM

19. Diagnosis and Treatment of Low Back Pain

weeks), subacute (4-12 weeks), or chronic (more than 12 weeks), and as such, the management of patients differs with the duration of the pain (see the Glossary in Appendix D for additional definitions). Axial/non-radiating LBP can be caused by mechanical problems, degenerative disc disease, facet joint arthropathy, or bulging or herniated intervertebral discs.[2] LBP may occur in the presence of radiculopathy or neurogenic claudication. The nature of pain in some patients may be myofascial (...) , a symptom of fibromyalgia, and for some have an important underlying psychological component. Signs and symptoms that indicate serious underlying pathology requiring additional diagnostic workup and prompt treatment are generally referred to as “red flags.” Table 1 lists some common serious spinal conditions and the red flags that indicate further investigation may be needed. The various treatments of axial/non-radiating LBP are categorized for this CPG as education and self- care, non-pharmacologic

2017 VA/DoD Clinical Practice Guidelines

20. Core Competencies for Management of Labour

• Performing a comprehensive assessment of maternal/ fetal/newborn well being using a variety of sources • Assessing fetal heart rate • Promoting maternal- newborn interaction and attachment behaviours • Assessing the appropriateness of labour admission • Identifying maternal-fetal risk factors • Recognizing the signs and symptoms, and progression of the labour and birth process • Evaluating progress in labour • Recognizing normal and variances in fetal wellbeing during labour • Recognizing the need (...) and expectations for labour support Review antenatal and clinical records Demographic information Obstetrical history Family history Medical/surgical history History of mental health History of present pregnancy, including LMP and EDD Laboratory and ultrasound results Birth and feeding plan Assess psychosocial and cultural factors Check maternal vital signs and urine dipstick Measure symphysis-fundal height Palpate abdomen to assess fetal lie, size, presentation, position, attitude and descent Confirm fetal

2014 British Columbia Perinatal Health Program

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