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    Patellofemoral Pain Syndrome

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    bjpalmer
    Patellofemoral pain syndrome is characterized by anterior knee pain that occurs with activity like descending stairs or prolonged sitting. It is often caused by overuse and can result from biomechanical issues like weakness of the quadriceps muscles or tightness of the iliotibial band. Treatment focuses on strengthening exercises, stretching, bracing, and orthotics, with surgery reserved for rare cases.

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    Patellofemoral Pain Syndrome

    Uploaded by

    bjpalmer
    392 views24 pages
    Patellofemoral pain syndrome is characterized by anterior knee pain that occurs with activity like descending stairs or prolonged sitting. It is often caused by overuse and can result from biomechanical issues like weakness of the quadriceps muscles or tightness of the iliotibial band. Treatment focuses on strengthening exercises, stretching, bracing, and orthotics, with surgery reserved for rare cases.

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    Patellofemoral pain syndrome is characterized by anterior knee pain that occurs with activity like descending stairs or prolonged sitting. It is often caused by overuse and can result from biomechanical issues like weakness of the quadriceps muscles or tightness of the iliotibial band. Treatment focuses on strengthening exercises, stretching, bracing, and orthotics, with surgery reserved for rare cases.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    392 views24 pages

    Patellofemoral Pain Syndrome

    Uploaded by

    bjpalmer
    Patellofemoral pain syndrome is characterized by anterior knee pain that occurs with activity like descending stairs or prolonged sitting. It is often caused by overuse and can result from biomechanical issues like weakness of the quadriceps muscles or tightness of the iliotibial band. Treatment focuses on strengthening exercises, stretching, bracing, and orthotics, with surgery reserved for rare cases.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 24
    At a glance
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    Patellofemoral pain syndrome is a condition causing anterior knee pain resulting from physical and biochemical changes in the patellofemoral joint.

    Anterior knee pain that occurs with activity and is often worse when descending steps or hills. Can be triggered by prolonged sitting and may be unilateral or bilateral.

    Potential causes include overuse, biomechanical issues like pes planus or pes cavus, muscular weakness or inflexibility, and abnormal Q angle.

    Patellofemoral Pain

    Syndrome

    07/18/09 Patellofemoral Pain Syndrome 1


    Definition
     Retropatellar or peripatellar pain
    resulting from physical and
    biochemical changes in the
    patellofemoral joint.

    07/18/09 Patellofemoral Pain Syndrome 2


    Patient’s
    Presentation
     Patients with patellofemoral pain
    syndrome have anterior knee pain
    that typically occurs with activity.
     Often worsens when they are
    descending steps or hills.
     Can be triggered by prolonged
    sitting.
     Unilateral or bilateral

    07/18/09 Patellofemoral Pain Syndrome 3


    Pathophysiology
    and Etiology
     A common misconception is that the
    patella only moves in an up-and-
    down direction.
     Patella also tilts and rotates.
     This pain should not be confused
    with pain that occurs directly on the
    patellar tendon (patellar tendonitis).
     Etiology is multifactorial.
    Overuse and
    Overload
     Often classified as an overuse injury.
     Repeated weight-bearing impact may be a
    contributing factor, particularly in
    runners.
     Steps, hills and uneven surfaces tend to
    exacerbate patellofemoral pain.
     Once the syndrome has developed, even
    prolonged sitting can be painful
    ("movie-goer's sign") because of the extra
    pressure between the patella and the
    femur during knee flexion.

    07/18/09 Patellofemoral Pain Syndrome 5


    Biomechanical and
    Muscular Dysfunction
     Pes Planus (Pronation)
     This condition often occurs in
    patients who lack a supportive
    medial arch.
     Foot pronation causes a

    compensatory internal rotation of


    the tibia or femur (femoral
    anteversion) that upsets the
    patellofemoral mechanism.

    07/18/09 Patellofemoral Pain Syndrome 6


    Biomechanical
    and Muscular
    Dysfunction
     Pes Cavus (High-Arched Foot,
    Supination)
     This places more stress on the
    patellofemoral mechanism,
    particularly when a person is
    running.

    07/18/09 Patellofemoral Pain Syndrome 7


    Q Angle
     “Normal" Q angles vary from 10 to
    22 degrees, depending on the study,
    and measurements of the Q angle in
    the same patient vary from
    physician to physician.
     Reliability - ?
    Muscular Causes
     “Weakness" vs “Inflexibility“
     Weakness of the quadriceps muscles
    is the most often cited area of
    concern.

    07/18/09 Patellofemoral Pain Syndrome 9


    Etiology Pathophysiology

    Weakness of the quadricep 1. The "quads" include the vastus


    medialis obliquus (VMO),
    vastus intermedius, vastus
    lateralis and rectus femoris.
    2. Weakness may adversely
    affect the patellofemoral
    mechanism.
    3. Quad-muscle strengthening is
    often recommended.
    Etiology Pathophysiology

    Weakness of the medial 1. Weakness of the VMO allows the


    patella to track too far laterally.
    quadriceps, specifically VMO.
    2. VMO strengthening is often
    recommended.
    3. VMO is a difficult muscle to isolate,
    and most patients find general
    quadriceps strengthening easier to
    accomplish.
    Etiology Pathophysiology
    Tight iliotibial bands 1. A tight iliotibial band places
    excessive lateral force on the patella
    and can also externally rotate the
    tibia, upsetting the balance of the
    patellofemoral mechanism.
    2. This problem can lead to excessive
    lateral tracking of the patella.
    Etiology Pathophysiology

    Tight hamstring muscles Tight hamstrings place more


    posterior force on the knee,
    causing pressure between
    the patella and femur to
    increase.
    Etiology Pathophysiology
    Weakness or tightness of the 1. The VMO originates on
    hip muscles (adductors, the adductor magnus
    abductors, external rotators) tendon. This is the
    anatomic basis for
    recommending adductor
    strengthening.
    2. Abductor (gluteus medius)
    strengthening helps to
    stabilize the pelvis.
    3. Dysfunction of the hip
    external rotators results in
    compensatory foot
    pronation.
    Etiology Pathophysiology

    Tight calf muscles 1. Tight calves can lead to


    compensatory foot
    pronation.
    2. Increase the posterior
    force on the knee.
    Exercises and
    Physical
    Medicine
     Quadriceps strengthening is most
    commonly recommended because the
    quadricep muscles play a significant role
    in patellar movement.
     Hip, hamstring, calf and iliotibial band
    stretching may also be important.
     Patients may not experience improvement
    of symptoms for six weeks or much longer,
    and the syndrome may recur.

    07/18/09 Patellofemoral Pain Syndrome 16


    Rest
     Theory that patellofemoral pain is
    an overuse/overload syndrome has
    merit.
     A patient with the movie-goer's sign
    can benefit from straightening the
    leg or walking periodically as
    needed.

    07/18/09 Patellofemoral Pain Syndrome 17


    Ice and Anti-
    inflammatory
    Medications

     Ice is the safest anti-inflammatory


    "medication," but its successful use
    requires discipline.
     Applying ice for 20 to 30 minutes after
    activity is recommended.
     Patients with patellofemoral pain
    syndrome have not been conclusively
    shown to benefit from anti-inflammatory
    drugs (NSAIDs).

    07/18/09 Patellofemoral Pain Syndrome 18


    Knee Sleeves and
    Braces
     Controversial
     Knee braces have a C-shaped lateral buttress that
    keeps the patella from deviating too far laterally.
     Knee braces are probably best reserved for use in
    patients with lateral subluxation that can be seen
    with the naked eye and can be easily palpated.
     The use of a knee brace or sleeve should not be
    considered a substitute for therapeutic exercises.

    07/18/09 Patellofemoral Pain Syndrome 19


    Footwear
     Generally speaking, the quality and
    age of footwear are more important
    than the brand name.
     Most runners, for example, change
    their shoes every 300 to 500 miles.

    07/18/09 Patellofemoral Pain Syndrome 20


    Arch Supports and
    Custom Orthotics
     Arch support may improve lower
    extremity biomechanics by
    preventing overpronation in pes
    planus and by providing a broader
    base of support for the normal or
    pes cavus foot.

    07/18/09 Patellofemoral Pain Syndrome 21


    Surgery
     Surgery for patellofemoral pain syndrome
    is considered a last resort.
     True chondromalacia (fraying of the
    retropatellar cartilage) may be amenable
    to an arthroscopic surgical procedure to
    smooth out the undersurface of the
    patella.

    07/18/09 Patellofemoral Pain Syndrome 22


    Imaging
     Imaging should be considered to rule out
    unusual conditions such as osteochondritis
    dissecans, infection or neoplasm.
     In general, six weeks of no improvement
    in a compliant patient, particularly if the
    symptoms are unilateral, is a reasonable
    period to wait before ordering plain-film
    radiographs.

    07/18/09 Patellofemoral Pain Syndrome 23


    Treatment
    Recommendations
     Initial conservative approach;
     (1) relative rest with consideration of a temporary
    change to nonimpact aerobic activity.
     (2) quadriceps strengthening.
     (3) evaluation of footwear.
     (4) icing, especially after activity.

    07/18/09 Patellofemoral Pain Syndrome 24

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