PATELLOFEMORAL PAIN SYNDROME
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||Patellofemoral pain syndrome describes a
variety of possible disorders that cause pain in the joint between
the kneecap (Patella) and the thigh bone (Femur).
and X-ray of a Normal Knee
||Patellofemoral pain syndrome is known by
other names such as: Patellar Chondromalacia, Excessive Lateral
Pressure Syndrome and simply Anterior Knee Pain. It is a very common
problem especially in women.
The pain associated with this disorder may worsen with descending
stairs climbing or deep squating. Sitting with your knees flexed for
a long period of time in a car or movie theatre may also aggravate
||A variety of underlying anatomic
abnormalities may result in patellofemoral pain syndrome. It can be
caused by softening or cracking of the articular cartilage under the
kneecap. This is known as chondromalacia. A malalignment of the
kneecap or tight tissue around the kneecap can also create tension
that may lead to patellofemoral pain syndrome.
Usually, this disorder arises without a history of significant
trauma. Occasionally, the pain may begin after a blow to the knee or
a minor injury.
pictures of a normal kneecap and one with chondromalacia
||Patellofemoral pain syndrome patients
complain of pain in the front of the knee. This pain may be
localized but more often is diffuse. The pain may be made worse by
descending stairs or sitting with a flexed knee for an extended
period of time. The patient may also complain of occasionally giving
way or a grinding sensation behind the kneecap.
The physical exam is critical to confirming the diagnosis. On
inspection of the knee, an assessment of the alignment of the
kneecap is done. The kneecap should fall in the center of the thigh.
If it is riding on the outside portion of the knee or appears to
tilt with knee bending, the patient is at higher risk for
patellofemoral pain syndrome. Evaluation of the quadriceps muscle
strength (especially its inside portion, the vastus medialis obliqus
or VMO) is essential. Palpation of the kneecap and finding the area
of maximal tenderness is done next. Assessing the kneecap for
restricted movement and possible instability are other important
components of the physical exam. Checking the knee for fluid (an
effusion in medical terms) should also be done. Finally, it critical
to evaluate the patient's quadriceps (thigh muscle) flexibility.
This can be done by having the patient lie on their stomach and
attempt to pull their heel toward their buttock. Comparison to the
opposite side will help in this assessment.
X-rays, CT Scans and or MRI Scans may be used to confirm the
These phases may be directed by your physician or may be done under
the supervision of a physical therapist. The exercise program should
be designed to improve quadriceps and hamstring flexibility and
emphasize VMO strengthening. Taping of the kneecap by a therapist
may also provide some relief of the symptoms.
||Control of pain and inflammation with Rest,
Icing, Stretching, Anti-inflammatory medication (RICE)
||Restore strength and function with
continued stretching and a strengthening program.
||Return to sports or work via a customized
program of exercises designed to maintain flexibility,
coordination and endurance
It may also be important to evaluate the patient's feet for
orthotics if excessive pronation is present or consider bracing for
the kneecap if it is unstable.
If nonoperative measures fail, surgery may be required to smooth
the articular cartilage or release tight structures around the
kneecap. The operation may take the form of minimally invasive
arthroscopic surgery or may require an open kneecap realignment
procedure. Any surgery for this disorder should be individualized to
the patient and is best discussed with the surgeon of your choice.
Surgery--smoothing of the knee cap cartilage
Avoid training error such as overuse and knee extension
Maintain strong and flexible quadriceps and hamstring muscles.
Always warm up before playing or training.