Joint effusion is a common clinical problem throughout the world. Synovial fluid analysis is one of the most important diagnostic tests to differentiate various inflammatory and non-inflammatory joint diseases. Gross examination and cell count of synovial fluid are two important test modalities. A comparison of performances of the tests would enable us to emphasize on the diagnostic procedures for better outcomes. A total of 105 cases were included in this study, performances of the tests such as accuracy, sensitivity, specificity, positive and negative predictive values of each test modality were calculated for comparison. Joint effusions were diagnosed as 19 rheumatoid arthritis, 12 non- inflammatory, 15 inflammatory, 14 infective, 7 tubercular, 4 traumatic, 6 osteoarthritis, 5 crystal induced arthritis, 6 non- specific arthritis and 8 normal cases. Accuracy, sensitivity, specificity, PPV and NPV of cell count were 76.19%, 72.72%, 94.11%, 98.46% and 40% respectively and accuracy, sensitivity, specificity, PPV and NPV of gross examination were 71.42%, 68.18%, 88.23%, 96.77% and 34.88% respectively. The individual parameters of synovial fluid study overlaps among each other test modalities and a combination of test procedures would yield better performances for diagnosis.