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Knee CPGs > Patellafemoral pain > Flashcards

Patellafemoral pain Flashcards

1
Q

What are the classic diagnostic signs of patellafemoral pain?

A
  1. Presence of retropatella/ peripatellar pain (A)
  2. pain with squatting, stair climbing, sitting for long periods (A/B)
  3. Exclusions of all other conditions that may cause anterior knee pain (B)
  4. Positive patella tilt test with hypomobility (C)
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2
Q

What are the 4 different PFP classification subcategories? Best ways to treat?

A
  1. Overuse/ overload without other impairment- increased magnitude/ frequency and not allowing rest- taping/ rest
  2. Muscle performance deficits- benefit from knee/ hip strength
  3. Movement coordination deficits- dynamic knee valgus and gait training
  4. Mobility impairments- hypo- muscle flexibility to lower limb- stretching/ STM to lateral retinuaculum, hypermobile feet- orthotics/ taping
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3
Q

What outcome measures should you use for PFP

A
  1. Anterior Knee pain scale (AKPS)
  2. KOOS- PF- Patella femoral pain and knee OA subscale
  3. EPQ- Eng and Pierrynowski Questionairre
  4. VAS/ NRPS
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4
Q

What physical performance measures should be completed when assessing PFP?

A
  1. Squatting
  2. Step downs
  3. SLS- single leg squat
    (B evidence)
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5
Q

What physical impairment measures should be completed when assessing PFP?

A
  1. Patella provocation
  2. Patella mobility
  3. foot position
  4. Hip and muscle strength
  5. Muscle length
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6
Q

What specific modes of exercise can be recommended for exercise therapy

A

hip strength targeting posterolateral musculature- may be preferred in early stages
Weight bearing (resisted squats)
Non weight bearing knee strength (resisted knee extension)
(A evidence)

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7
Q

What recommendation can be made about patellar taping

A

Tailored patella taping in the short term to help correct lateral tilt/ glide/ rotaton along with exercise with goal fo pain reduction. Not for long term or to improve muscle function. (I/B evidence)

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8
Q

What recommendation can be made about patella femoral bracing

A

Should not prescribe (B evidence)

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9
Q

What recommendations can be made about foot orthoses and PFP?

A

Pre-fabcricated for those with excessive pronation in the short term (up to 6 weeks) in combination with exercise therapy

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10
Q

What recommendations can be made about biofeedback and PFP

A

Not recommended- EMG on Vastus medialis nor visual biofeedback during exercise (B evidence)

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11
Q

What gait retraining cues could you use for runners with PFP?

A

cues to adopt forefoot strike pattern (for rearfoot runners), increase running cadence, cuing to reduce peak hip adduction
(C evidence)

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12
Q

Is dry needling recommended for those with PFP? What about acupuncture

A

A evidence- should NOT use

C evidence- may use acupuncture if within scope

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13
Q

Is manual therapy recommended for those with PFP? What about biophysical agents?

A

Manual therapy shouldn’t be used alone- A evidence

Should NOT use biophysical agents- cryo, ionto, ESTIM, laser, U/S- B evidence

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14
Q

What combined interventions can you use for PFP?

A

Exercise key component, foot orthoses, patella taping, patella mobilizations, and lower limb stretching- A evidence

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15
Q

What is the recurrence rate like with PFP?

A

70-90%

50-56% had persistent knee pain for over 2 years

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16
Q

describe the pathoanatomical features of the PFJ

A

Articulation between patella and trochlear groove
Functions to increase the moment arm of the quads, bony protection of the femoral condyles with flexed knee, prevent damage of compressive forces on quad tendon with resisted knee extension

17
Q

On palpation, where might the patient have pain

A

Distal pole/ medial aspect of patella, medial plica, and medial femoral condyle. Potentially pain with grinding/ compression

18
Q

What is the relationship between PFP and hip weakness?

A

Hip abductor, extensor, and external rotator weakness is likely a result of PFP, not a direct cause

19
Q

What statistics are noted with sports and PFP

A

Women and participation in a single sport put at higher risk

20
Q

What is the relationship between foot mechanics and PFP

A

Inconclusive and conflicting evidence for altered foot mechanics and PFP

21
Q

List predictors of poor outcomes for PFP patients

A

Longer duration of symptoms before intervention
Overall poor function
higher baseline pain severity
negative Psychological stress
Altered pain sensitization
approach of avoiding pain provoking activities

22
Q

What is the relationship between PFP and PFOA

A

They may be related, similar presentation, but lacking evidence for cause- effect

23
Q

What are the two most accurate diagnostic tests for PFP

A
  1. reproduction of retropatellar pain during squatting (performed in a manner that feels normal to the individual)
  2. Hypomobility (positive) with patellar tilt test- looks at lateral retinaculum tightness
24
Q

Define the overuse/ overload subcategory and the types of patients you might see

A

too much load magnitude- amount of PFJ loading resulting from physical activity
too much load frequency- amount of repetition of an activity
military/ runners- either elite of those than ran less than 5 hours/ week

25
Q

In the mobility impairments category- what are the muscles/ body structures most likely involved and what should you test?

A

increased foot mobility- assess with Foot Posture index or looking at difference in midfoot width in WB and NWB
lack of flexibility in hamstrings, quads, gastroc, soleus, lateral retinaculum, or ITB
Hip IR/ ER ROM testing

26
Q

In addition to the Ottawa knee rule, what is the other knee prediction rule and what population is better for each?

A

Pittsburg knee decision rule- persons of all ages

Ottawa- more sensitive- limited to 18 and up

27
Q

What is a valid screening tool for red flags?

A

Optimal Screening for Prediction of Referral and Outcome- review of systems (OSPRO- ROS)

28
Q

What are some different diagnostics to be mindful of when screening for knee pain to refer out for?

A

Tumors, Dislocation, Septic Arthritis, Arthrofibrosis, DVT, Neurovascular compromise, Fracture- at knee or hip, SCFE in kids/ adolescents

29
Q

What are some different diagnostics to be mindful of when screening for knee pain that we can treat?

A

referred pain- lumbar, peripheral nerve entrapment, hip OA, ligament, meniscus, articular cartilage, OA, ITB syndrome, quad/ patellar tendonitis, plica syndrome, patellar instability- subluxation/ dislocation, patella (Sindings- Larsen- Johansson lesion) or tibial (Osgood Schlatter) Apophysitis

30
Q

What special test can rule out ITB syndrome? Describe the test and what population its most likely to be seen with

A

Noble Compression Test- pain with palpation to lateral femoral epicondyle with knee in 30 deg flexion
Runners with lateral knee pain running 1.2 km or longer

31
Q

How would you differentiate with PFP and patella tendonitis

A

Pain located over the top of the patella tendon and is aggravated by activities that load the knee extensors- like jumping, high speed sprinting

32
Q

What special test can be performed to diagnose patellar instability?

A

apprehension with lateral patella movement

h/o dislocation

33
Q

In children, where should you palpate to r/o apophysitis?

A

tibial tubercle- Osgood Schlatter

inferior pole of patella- Sinding Larsen Johannson

34
Q

What special test (s) would you do if you suspect overuse/ overload classification of PFP?

A

Eccentric step down test- moderate specificity

35
Q

What special test (s) would you do if you suspect PFP with movement coordination deficits?

A

Dynamic valgus on lateral step down test

Frontal plane valgus

36
Q

What special test (s) would you do if you suspect muscle performance deficits?

A

Thigh strength testing
Hip SIT- hip stability Isometric test- measures strength of entire posterolateral hip musculature- with strap and dynomometer

Knee CPGs (4 decks)

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