Download What Is Patellofemoral 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 pain (around the
kneecap) arising from overuse
and overload of the
patellofemoral joint or from
biomechanical or muscular
changes in this joint.
Causes
• Softening of the cartilage behind the
patella(Chondromalacia)
• Malalignment of patella
• Tightening of tissue around patella
• Overuse of patellofemoral joint
–
Occurs when the pressure between the patella and its contact
points on the femur increase as the knee is bent.
• Overload
– Typically affects inactive patients who suddenly increase activity
and stress to the joint.
• Large Quadriceps Angle
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.
Muscular dysfunction problems
• Includes weakness of the quadriceps, tight
iliotibial bands, tight hamstrings, weakness or
tightness of the hip muscles, or tight calf
muscles.
Extrinsic Risk Factors
• Includes poor technique, low quality sports, or a
poorly designed or intensive training program.
Patient population most commonly
affected by this condition?
• Commonly occurs in adolescents and young
adults, who regularly participate in high-impact
sporting activities, such as running, basketball,
and football.
• Most commonly found in women
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 damage
– Variable cartilage damage
– Normal cartilage
• Patellofemoral Pain Syndrome can be difficult to
diagnose; however, x-rays can confirm or refine a
suspected clinical diagnosis.
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 extended
– Gradual or acute onset of anterior knee pain
– Pain behind or around the kneecap
• Pain is exacerbated by running, squatting, jumping,
prolonged sitting, or ascending/descending stairs
– Catching sensation under the patella
Clinical Presentation
• Patients with Patellofemoral Pain Syndrome
classically present as either:
– Retropatellar pain (pain behind the kneecap)
– Peripatellar pain (pain around the kneecap)
Clinical Presentation
• Signs:
–
–
–
–
–
–
–
Soft tissue swelling
Effusion
Bruising
Restricted joint movement
Patellofemoral deformities
Tenderness
Reduced weight-bearing ability
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.
– Pronation
– Patellar mobility
– Patellar tracking
– Q-angle
measurement
– Medial and lateral
translation
– Quadriceps
flexibility test
– Obers test
– Hip extensor rotator
muscle strength test
– Hughston’s test: This
test is used to rule
out presence of Plica
syndrome
Goals of treatment
•
•
•
•
Reduce Inflammation
Reduce pain
Increase muscle strength and endurance
Restore movement and function
Physical Therapy
• Strengthening exercises
– Focus on Quadriceps and Hip Abductors
• Stretching exercises
– Focus on Quadriceps, Hamstring, Iliotibial Band, and
Gastrocnemius
• Modalities
– Icepacks and Ultrasound can be used to reduce pain
and inflammation
• Evaluation of footwear
– Careful choice of footwear can minimize the risk of
developing the condition and alleviating existing pain
Pharmacotherapy
• NSAIDs
– Used to reduce pain and inflammation
Arthroscopic Surgery
• Used to examine the articular cartilage
surrounding the patella and the patellofemoral
groove and smooth off any rough surfaces.
Lateral Release Surgery
• Used to re-correct the alignment of the patella by
cutting the ligaments on the outside of the
patella.
What is the outcome of treatment?
• Refer to orthopedic surgeon if condition is
severe enough to require surgery
• Physical therapy
– Improve lower extremity strength
– Improve lower extremity flexibility
• Prognosis: Good
Prevention
• Avoid high impact activities that will
exacerbate the condition
– Walking up stairs
– Squatting
• Use appropriate athletic shoe with proper
arch support
References
• Ferri: Ferri’s Clinical Advisor 2011, 1st
Edition. Copyright © 2010 Mosby, An
Imprint of Elsevier.
• Lazoff, Marie. First Consult. Elseiver Inc.
Copyright © 2011