Patellofemoral Pain Syndrome

From Anvita Health Wiki

Contents 1 Etiology 2 Epidemiology 3 Clinical-manifestations 4 Radiology 5 Differential-diagnosis 6 Management 7 More General Terms 8 Additional Terms 9 References

Etiology

• pain originating from irritation of the rich innervated subchondral bone & soft tissues around the patella
• risk factors

• developmental anomalies
• overuse
• abnormal patellar tracking

• excessive Q angle, shallow intercondylar sulcus, deformed patellar facets, weakness of the vastus medialis obliquus muscle, dysfunction of the medial or lateral retinaculum

Epidemiology

• frequently encountered in young athletes
• young female runners

Clinical-manifestations

• vague, dull achy peripatellar pain
• referred pain to the medial joint line & popliteal fossa
• pain descending stairs
• pain after prolonged sitting
• pain on palpation of the medial articular surface of the patella
• compression of the patella reproduces the pain
• apprehension &/or quadriceps inhibition against resistance applied to the superior pole of the patella
• positive crepitus test
• positive compression test
• positive shrug test

Radiology

• radiographs are generally not helpful
• patellofemoral osteoarthritis may be confirmed by a radiographs obtained with the knee in a flexed position
• chondromalacia patellae may be associated with softening & erosion of patellar cartilage
• other radiology testing is generally not helpful

Differential-diagnosis

• patellar chondromalacia

• older patients
• in association with trauma or malalignment

• patellar subluxation

• giving way, popping or locking of knee with activity
• marked lateral patellar mobility
• apprehension of physical examination

Management

• relative rest
• non-steroidal anti-inflammatory drugs ( NSAIDs)

• pain relief in acute cases
• use should not continue more than 2 weeks
• may be useful before & after exercise in patients with periodic exacerbation of symptoms

• physical therapy

• strengthening quadriceps, especially vastus medialis obliquus to offset lateral tracking of patella
• physical therapy should not increase pain
• ice for 15-20 minutes after activity for up to 2-3 months

• knee bracing

• used to correct abnormal patellar tracking
• no well-controlled trials demonstrating benefit

• medial patellar taping
• surgery

• failure of 3-6 months of medical management
• procedures

• releasing lateral retinaculum
• tightening medial retinaculum
• transposing the vastus medialis obliquus tendon
• transferring patellar tendon to a more medial position
• in older patients with chondromalacia, arthroscopic or open debridement may offer relief

More General Terms

• musculoskeletal disease/disorder
• knee pain
• syndrome

Additional Terms

• patella (kneecap)
• patellofemoral joint

References

1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 812-13
2. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998

patellofemoral pain syndrome (PFPS)