PF disorders part 2

Question 1

summarize PFP rehab

Answer 1

• avoid exacerbating activities
• improve lower limb mechanics and NM control
• improve hip strength and quad strength
• correct patellar positioning and tracking
• stretching and mob of quads, HF, calves, hip, lumbar, ankle, knee joints

Question 2

what should you not do for PFP?

Answer 2

• manual therapy in isolation
• dry needling
• biophysical agents like cryo, US, iontophoresis, ESTIM, laser

Question 3

explain patellar subluxation/dislocation

Answer 3

• lateral displacement most common
• commonly occurs with knee in 20-30 degrees of flexion but may also have valgus load at knee
• may have associated fracture of patella, osteochondral fracture of patellar or femur and/or chondral defect

noncontact injury: femur goes into IR and adduction with very strong quad contraction
if they have had dislocation: get imaging

Question 4

what are the structural patellar instability risk factors?

Answer 4

• patellar hypermob
• increased q angle
• shallow trochlear groove
• flat patella

Question 5

what are the NM patellar instability risk factors?

Answer 5

• dynamic valgus pattern

- hip msucle weakness

Question 6

what is the q angle?

Answer 6

• ASIS to middle patella to tibial tuberosity
  males: 10-14
  females: 15-17

Question 7

what happens wtih patellar subluxation/dislocation

Answer 7

• effusion
• common damage to distal attachment of medial quad tendon
• medial retinaculkum and medial patellofemoral ligament damage
• evaluated w apprehensino test and moving/dynamic patellar apprehension test

Question 8

what is post patellar subluxation/dislocation rehab?

Answer 8

• R/O fracture
• reduce effusion by RICE
• restore rOM and muscle function (full ROM at 8-10 weeks)
• brace if unstable
• correct altered movement patterns

to reduce dislocation: extend knee and push patella medially