Pain Syndrome What is Patellofemoral Pain Syndrome Patellofemoral Pain Syndrome is a spectrum of processes all characterized by retropatellar pain behind the kneecap or peripatellar ID: 326981
Download Presentation The PPT/PDF document "Patellofemoral" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Patellofemoral
Pain
SyndromeSlide2
What is
Patellofemoral Pain Syndrome?
Patellofemoral Pain Syndrome is a spectrum of processes all characterized by retropatellar pain (behind the kneecap) or peripatellar pain (around the kneecap) arising from overuse and overload of the patellofemoral joint or from biomechanical or muscular changes in this joint.Slide3
Causes
Softening of the cartilage behind the patella(
Chondromalacia)Malalignment of patellaTightening of tissue around patellaOveruse of patellofemoral joint
O
ccurs
when the pressure between the patella and its contact points on the femur increase as the knee is
bent.
Overload
T
ypically
affects inactive patients who suddenly increase activity and stress to the joint
.
Large Quadriceps AngleSlide4
Other Contributory CausesSlide5
Biomechanical problems
Includes
pes planus (pronation of the foot), pes cavus (supination of the foot),
hyperpronation
, tibial torsion,
patellofemoral
malalignment
, femoral anteversion, and leg length discrepancies. Slide6
Muscular dysfunction problems
Includes weakness of the quadriceps, tight
iliotibial bands, tight hamstrings, weakness or tightness of the hip muscles, or tight calf muscles.Slide7
Extrinsic Risk Factors
Includes
poor technique, low quality sports, or a poorly designed or intensive training program.Slide8
Patient population most commonly affected by this condition?
C
ommonly occurs in adolescents and young adults, who regularly participate in high-impact sporting activities, such as running, basketball, and football.Most commonly found in womenSlide9
Diagnosis
The diagnosis of
Patellofemoral Pain Syndrome is dependent on findings from the patient’s medical history and physical examination.Diagnosis of Patellofemoral Pain Syndrome is divided into three general categories:Presence of cartilage damageVariable cartilage damageNormal
cartilage
Patellofemoral
Pain Syndrome can be difficult to
diagnose;
however, x-rays can confirm or refine a suspected clinical
diagnosis.Slide10
Clinical Presentation
Physical exam findings consistent with
Patellofemoral Pain Syndrome include the following:Pain is elicited by compression of the patella into the trochlear groove while the leg is extendedGradual or acute onset of anterior knee painPain behind or around the kneecapPain is exacerbated by running, squatting, jumping, prolonged sitting, or ascending/descending stairsCatching sensation under the patellaSlide11
Clinical Presentation
Patients with
Patellofemoral Pain Syndrome classically present as either:Retropatellar pain (pain behind the kneecap)Peripatellar pain (pain around the kneecap)Slide12
Clinical Presentation
Signs:
Soft tissue swellingEffusionBruisingRestricted joint movementPatellofemoral deformitiesTenderness Reduced weight-bearing abilitySlide13
Examination
A careful examination should be performed in both the prone and supine positions.
Systematic palpation should be used to reproduce the patient’s complaint and localize areas of tenderness. A weight-bearing examination should also be done to assess obesity, atrophy, leg length, knee alignment, torsional deformities, and foot position. The patient should also be examined for effusion, soft tissue swelling, bruising, and position, size, and shape of
patella.Slide14
Physical examination
will
include the following measurements:Slide15
Pronation
Patellar
mobilityPatellar trackingSlide16
Q-angle
measurement
Medial and lateral translationQuadriceps flexibility testSlide17
Obers
testHip extensor rotator muscle strength testHughston’s test: This test is used to rule out presence of Plica syndromeSlide18
Goals of treatment
Reduce Inflammation
Reduce painIncrease muscle strength and enduranceRestore movement and functionSlide19
Non-operative TreatmentSlide20
Physical Therapy
Strengthening exercises
Focus on Quadriceps and Hip AbductorsStretching exercisesFocus on Quadriceps, Hamstring, Iliotibial Band, and Gastrocnemius ModalitiesIcepacks and Ultrasound can be used to reduce pain and inflammationEvaluation of footwearCareful choice of footwear can minimize the risk of developing the condition and alleviating existing painSlide21
Pharmacotherapy
NSAIDs
Used to reduce pain and inflammationSlide22
Operative TreatmentSlide23
Arthroscopic Surgery
Used to examine the articular cartilage surrounding the patella and the
patellofemoral groove and smooth off any rough surfaces.Slide24
Lateral Release Surgery
Used to re-correct the alignment of the patella by cutting the ligaments on the outside of the patella.Slide25
What is the outcome of treatment?
Refer to
orthopedic surgeon if condition is severe enough to require surgeryPhysical therapyImprove lower extremity strengthImprove lower extremity flexibilityPrognosis: GoodSlide26
Prevention
Avoid high impact activities that will exacerbate the condition
Walking up stairsSquattingUse appropriate athletic shoe with proper arch supportSlide27
References
Ferri
: Ferri’s Clinical Advisor 2011, 1st Edition. Copyright © 2010 Mosby, An Imprint of Elsevier.Lazoff, Marie. First Consult. Elseiver Inc. Copyright © 2011