Knee Unit- Patellofemoral Syndrome nonsurgical Flashcards
written exam only
What is Patellofemoral Syndrome?
-abnormal tracking of the patella between the femoral condyles
>Places increased and misdirected forces between the patella and femur
What is the most common way the patella tracks with Patellofemoral Syndrome?
patella pulled too far laterally during knee extension
What does Patellofemoral Syndrome cause damage to?
the articular cartilage of the patella
> Ranges from softening of cartilage to complete destruction resulting in exposure of subchondral bone
Etiology of symptoms?
ON P.EXAM “explain pt’s etiology”
-Explain arthritis
-Exact etiology unknown
>Common in adolescence
>Prevalent in females
>Direct trauma
>Overuse
»_space;Direct association with activity level of patient
>In older population, associated with OA -degeneration
>Faulty patellar tracking from malalignment due to anatomic variations or soft tissue imbalances
>A combination of these factors
Common impairments for patellofemoral syndrome?
- Weakness, inhibition or poor recruitment or timing of firing of the VMO
- Overstretched medial retinaculum
- Restricted lateral retinaculum, IT band, or fascial structures around patella
- Tight gastroc/soleus, hamstring, psoas, vastus lateralis or rectus femoris
- Patella alta
- Insufficient lateral femoral condyle
- Excessive pronation
- Excessive knee valgus
- Increased Q angle
What are the common fxn limitations?
- Pain or poor knee control when descending or ascending stairs (w/o knee buckling)
- Pain with walking, jumping, or running interfering during ADL’s, work , recreational and sports activities
- Pain and stiffness with prolonged flexed knee postures such as sitting or squatting
What are the clinical presentations?
- gradual onset of anterior knee pain following increase in activity
- Pain located behind the patella
- Exacerbated with activities that increase patellofemoral compressive forces
- Point tenderness over lateral border of patella
- Creptius when patella manually compressed into trochlear groove
- Quad atrophy - VMO
How is this diagnosed?
- X-rays to rule out a fracture, examine the configuration of the PF joint and identify potential osteophytes, joint space narrowing, patella alta and arthritic changes
- Arthrogram and arthroscpy can be used to examine articular cartilage
- Special test – Clarks sign
What is the Clarks sign test?
PTA puts pressure immediately proximal to the upper pole of the patella and asks pt to contract quads isometrically; + if pain or can’t fully contract
Differential diagnosis
Rule out:
- Referred pain from hip
- Osgood-Schlatter syndrome
- Neuroma
- *Patellar tendonitis
- Plica syndrome - when plica which is an extension of the synovial capsule becomes irritated , enlarged or inflamed)
- Infection
What is Patellar Tendonitis?
-Overuse condition characterized by inflammatory changes of the patellar tendon
>Prevalent in athletes who repetitively jump
>Primary complaint is knee pain over the anterior portion of the knee with jumping or stairs
-Point tenderness over superior pole of the patella tendon
How to manage symptoms? (conservative)
-meds
-PT
>Controlling edema
>Stretching
>Strengthening
>Improving ROM
>Activity modification
Important Rehab Considerations
IMPORTANT-Precautions
-Stress to the articulating surface of the patella varies during ROM
> Little or no contact from 0-15 degrees of flexion
Greatest patellar stress is at 60 degrees and compression loads at 75 degrees (AVOID THIS RANGE)
»_space;Where pathology is located will affect which portion of the range pain is felt
PT Interventions
-Patellar mobilization
>Increase medial glide to increase flexibility or lateral fascia
-Strengthening
>VMO in NWB and WB positions
>>Quad sets, SLR, minisquats
>Biofeedback
-Stretching
>HS, ITBand, TFL, Rectus femoris
-Patellar tapingNonoperative Management – Maximum Protection Phase
-Modalities
-Gentle motion
-Isometrics in pain free positions
-Rest
>Reduce irritating forces
>Brace or tape to unload the joint
