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MSK 1 > 11/1 - PFPS > Flashcards

11/1 - PFPS Flashcards

1
Q

what population is PFP most common in

A

frequent injury in runners
females > males

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2
Q

what injuries is PFP a common complaint of

A

ACL injury
meniscal injury

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3
Q

what is the most common knee disorder

A

PFPS

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4
Q

what is the etiology of PFPS

A

repetitive micro traumas

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5
Q

what are 3 factors that impact the etiology of PFPS

A
  1. posture & alignment
  2. LE biomechanics / motor control
  3. neuromuscular factors
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6
Q

how can posture and alignment can lead to PFPS

A

Q angle
foot pronation

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7
Q

what are LE biomechanics/motor control factors that can lead to PFPS

A

hip IR (hip control)
knee valgus
PFJ stress

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8
Q

what are neuromuscular factors that can lead to PFPS

A

gluteal strength
quad strength

  • importance of prox strength and instability as influences entire lower kinetic chain*
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9
Q

what is the primary function of the patella

A

facilitate knee ext

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10
Q

how does the patella facilitate knee ext

A

inc functional lever arm of ext mechanism (aka inc mechanical advantage)

-> inc force of extensor mechanism by as much as 50%

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11
Q

what are pathomechanics at the knee that can lead to PFPS

A

inc joint stresses & subsequent articular cartilage wear

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12
Q

traumatic vs acquired PFPS

A

think bilateral in absence of trauma

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13
Q

if cartilage is aneural, why is there pain associated w worn down articular cartilage

A

get pain if enough cartilage is worn down to get load on the subchondral bone

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14
Q

what are 3 risk factors for PFPS

A
  1. excessive foot pronation
  2. ms imbalances
  3. dec knee flex angles
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15
Q

top down vs bottom up mechanics

A

top down: hip influencing knee
bottom up: foot influencing knee

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16
Q

how can excessive foot pronation lead to PFPS

A

tibial IR -> femoral IR ->inc contact pressure on lat facets of patella

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17
Q

what ms imbalances can lead to PFPS and how

A

VMO and VL weakness
- dynamic stabilizers of knee

hip ABD & ER weakness
- valgus angle inc lat compressive forces

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18
Q

why can dec knee flexion angles lead to PFPS

A

dec contact area of patella

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19
Q

how are risk factors of hip IR, hip strength, and femoral inclination angle reflected in PFPS

A

inc hip IR
- not well controlled by musculature

dec hip strength
- ext, ABD, and overall

inc femoral inclination
- bony predisposition

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20
Q

does every patient w glut weakness develop PFPS

A

no
- other things besides prox strength

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21
Q

what is “movie goer’s sign”

A

pain w prolonged sitting
- seen in PFPS

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22
Q

PFPS incidence by gender

A

female > male

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23
Q

PFPS onset?

A

insidious, progresses

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24
Q

location of PFPS pain

A

peripatellar pain
- not really localized

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25
Q

what main ms weakness does PFPS present w

A

quad
gluts

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26
Q

what are 2 functions that cause PFPS pain

A
  1. pain w prolonged sitting
  2. inc pain w stairs & rising from chair
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27
Q

palpation to r/o meniscal pain

A

meniscus = very specific pain on palpation along joint line

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28
Q

palpation to r/o patellar tendinopathy

A

tendinopathy = localized and density changes in tissue

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29
Q

what are the 3 dx criteria for PFPS

A
  1. presence of retropatellar or peripatellar pain
  2. pain reproduced w squatting, stairs, prolonged sitting or PFJ loading activity in flex position
  3. exclusion of all other conditions that may cause ant knee pain (via palpation)
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30
Q

what are 3 types of assessment tools for PFPS

A
  1. patient reported outcome measures
  2. physical impairments measures
  3. physical performance measures
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31
Q

what are 5 physical impairment tests for PFPS

A

patella provocation
patellar mobility
foot position (pronated?)
hip & thigh ms strength
ms length

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32
Q

what are physical performance measures for PFPS

A

clinical tests that reproduce pain/assess LE movement coordination
- ex: squat, step-down, single leg squats

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33
Q

what are normal Q values

A

male: 10-15
female: 15-20

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34
Q

what is abnormal Q value

A

> 20deg

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35
Q

what is the Q angle usually in PFPS and how does this reflect down the chain to call PFPS

A

inc Q angle (>20deg)

genu valgum
femoral anteversion
tibial torsion
lat tibial tubercle

36
Q

what is a more important thing to consider about Q angle

A

how will it change during dynamic activities
- static position doesn’t tell us much

37
Q

what ms lengths are often shortened in exam findings of PFPS

A

hamstrings

38
Q

why is pronation a difficult issue to address in terms of PFPS

A

pronation is a triplanar movement (encompassing frontal and transverse) and PFPS is a predominantly sagittal plane problem

39
Q

how did foot mobility present in PFPS

A

inc mobility
- inc pronation

40
Q

describe the ratio that is preferred with the poles of patella

A

superior pole to inferior pole and inferior pole to tibial tub should be 1:1 ratio

41
Q

patella alta vs baja

A

alta:
- high
- unstable
- <0.8

baja:
- low
- compressive
- >1.2

42
Q

why is patella alta more unstable

A

need to get into inc and deeper position of flexion before patella engaged in trochlea

43
Q

what are 4 differential dx for PFPS

A
  1. tendinitis/tendinosis
  2. osgood-schlatters dz
  3. ITB friction syndrome
  4. meniscal or ligament path
44
Q

why is tendinitis/tendinosis a relevant differential dx for PFPS and how can you differentiate

A

both activity induced
palpation is key to differentiate
- PFP = diffuse, less localized
- patellar tendon = uncomfortable, specifically when palpate

45
Q

what is osgood-schlatters dz and what is the main population you see this in

A

bony deformity at tibial tub

younger pts w growth plates

46
Q

what is ITB friction syndrome

A

snapping as ITB crosses Gerdy’s tub at 30deg flex thought to be crepitus

47
Q

how does ITB syndrome present and why is it difficult to differentiate from PFPS? How can you try to differentiate?

A

ant/lat knee pain

challenging bc mechanism predisposing PFP is same that drives ITB syndrome

think ab prox influence

48
Q

how to differentiate meniscal/ligament path from PFPS

A

meniscal/ligament - event or MOI
- mechanical sx if meniscus
- special testing - ant/post drawer, varus/valgus testing of ligaments

PFPS is insidious onset

49
Q

what are 4 rehab interventions for overuse patellar tendinitis

A

NSAIDs, ionto, ice
restore ROM
restore flexibility
improve strength

50
Q

why is the rehab process longer in tendinosis vs tendinitis

A

change in quality of tissue takes longer in tendinosis bc of degenerative change

51
Q

what are 4 rehab interventions for overuse patellar tendinosis

A

active warm-up
friction massage
stretch quad
eccentric strengthening
- ie of quads

52
Q

how does osgood schlatters present on imaging and why is imaging an important component to have

A

separation
pronounced tibial tub

see amt of separation on XR

53
Q

what is a common population that is susceptible to osgood schlatters

A

inc running/jumping activity
adolescents - growth spurt component
- boys > girls

54
Q

what is the growth spurt component of osgood schlatters dz

A

bones growing faster than ms can keep up w –> inc tension

55
Q

what aggravates osgood schlatters sx

A

more pronounced w inc activity
- activity modification is important

56
Q

how does osgood schlatters resolve

A

self limiting as physes begin to close, will feel better

57
Q

what are the 3 primary functions of the ITB

A
  1. stabilize lat hip and knee
  2. resist hip ADD and knee IR
  3. fem and tib attachments
58
Q

why are the fem and tib attachments relevant to ITBS

A

atypical hip and foot mechanics potential causes of ITBS

59
Q

what population is ITBS really common in and why

A

common cause of lat knee pain in runners and cyclists
- lot of sagittal plane activity

60
Q

what are 2 risk factors in runners and cyclists that can lead to ITBS

A
  1. hip ABD weakness
  2. inc weekly mileage
61
Q

what are common running proximal mechanics seen in individuals w ITBS? how does this lead to ITBS? what is the suggested goal for treatment considering this

A

greater hip ADD and knee IR
- dynamic valgus position

inc ITB strain and compression against lat fem condyle

treatment should focus on controlling secondary plane motions

62
Q

what are distal mechanisms responsible for ITBS (3)

A
  1. greater rearfoot inversion angle at heel strike
  2. greater tibial IR thru stance phase
  3. overpronation
63
Q

when do you usually see overuse/overload w/o other impairments in PFPS

A

inc magnitude and/or frequency of PFJ loading

64
Q

what ms performance deficits are often seen in PFPS

A

hip - post-lat (gluts)
quads

65
Q

what are the 3 main impairments/deficits seen in PFPS

A
  1. ms performance deficits
  2. movement coordination deficits
  3. mobility impairments
66
Q

what movement coordination deficits are seen in PFPS and what is an important consideration of their cause

A

excessive/poorly controlled knee valgus during dynamic tasks

NOT d/t weakness

67
Q

what mobility impairments are seen PFPS

A

foot hypermobility
ms length
- HS, quad, GS, lat retinaculum, ITB

68
Q

what are recommended treatments specific to overuse/overload w/o other impairments leading to PFPS

A

activity modification
- relative rest in acute phase
- targeted interventions that can be performed w/o inc reactivity
- patellar taping

69
Q

what are recommended treatments for ms performance deficits seen in PFPS

A

hip and knee targeted exercise is best
posterolateral hip focus in early stages
- until reactivity is better

70
Q

what exercise has the greatest VMO activation

A

quad set

71
Q

why wouldn’t we want to introduce a ball to squeeze between legs during exercises with PFPS

A

drives them toward ADD or valgus
- not something we necessarily want to promote

72
Q

what was found in exercises that were working to target the VMO

A

no exercise that can preferentially activate vastus med over vastus lat

73
Q

what was found in the vastus med with pts w ant knee pain

A

no selective weakness of vastus med in pts w ant knee pain

74
Q

how should quad strengthening be viewed given what was found of the VMO activation in exercises

A

try to strengthen quads as one unit w VMO
- not isolating VMO

75
Q

why has VMO been getting more attention to target it for exercises

A

tends to be targetted bc irritation and fluid can pool and get swelling there
- contribute to dec ROM, pain around joint, and dec ms activation

76
Q

why should prox strengthening (at hip) be added to knee strengthening and stretching

A

improved function
dec pain

77
Q

how can treatment target movement coordination deficits

A

quality of movement
- motor control strategies
- feedback strategies (tactile, visual, mirror)

78
Q

what did concurrent hip and knee strengthening show gains in and what didn’t it show gains in compared to just knee strengthening

A

gains: dec pain, improve tolerance, improve function

no gains in strength
influencing motor control more than anything

79
Q

when addressing mobility impairments in PFPS, what should be considered with the treatments

A

consider kinetic chain
consider cause vs sx

80
Q

what ms lengths should be stretched in treatment of PFPS and why

A

rectus fem
ITB
- tension lat retinaculum
hamstrings
- knee flex
- patella engaged in trochlea
gastroc soleus
- compensatory pronation -> can drive valgus

81
Q

when is manual therapy an appropriate intervention for PFPS

A

when in combination w strengthenin

82
Q

what are 5 interventions that aren’t recommended for PFPS

A

dry needling
manual therapy (in isolation)
PF bracing
biofeedback
modalities
- US, ice, phono, ionto, estim, laser

83
Q

why was biofeedback used as an intervention in the past and why isn’t it used now for PFPS

A

used in past when giving feedback on med vs lat quad activation

limited evidence to support this now

84
Q

when is blood flow restriction (BFR) a viable option for PFPS

A

if pt can’t tolerate load or has contraindications to load w sx

85
Q

what is the first priority of treating PFPS and why

A

immediate pain relief
- to gain pt trust

MSK 1 (31 decks)

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