Patellofemoral Pain Syndrome

Summary of patellofemoral pain syndrome

1. Patellofemoral Pain Syndrome 2016 년 5 월 11 일 재활의학과 김 종 규

2. Peripatellar pain Common causes Patellar dislocation or subluxation Patellar tendinitis Osgood- Schlatter’s disease Sinding-Larsen-Johansson disease ITB friction syndrome Bursitis Osteoarthritis Patellar fracture Quadriceps strain Gaut Etc. 2016-05-11 2

3. Anterior Knee Pain Patellofemoral pain syndrome Patellofemoral joint syndrome Jumper’s knee Chondromalacia patellae Peripatellar synovitis 2016-05-11 3

4. Patellofemoral Pain Syndrome Anterior knee pain Most common cause in young population Young female atheletes Gradual onset Aggravated at Squat Stair up/down Sit to stand Knee flexion 2016-05-11 4

5. PFPS Sympoms Feeling of instability Localized pain Crepitus Edema Feeling of muscle weakness Cannot squat Cannot stair up/down 2016-05-11 5

6. PFPS Pain sources Peripatellar synovitis without obvious cartilage damage Soft tissues such as lateral retinaculum Infrapatellar fat pad Self limited conditions No disability Benign neglect 2016-05-11 6

7. Pathophysiology Increased tension of patella to lateral side due to Overpronation of foot Increased Q-angle VMO weakness Muscle power imbalance 2016-05-11 7

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9. Q-angle 2016-05-11 9

10. Q-angle 2016-05-11 10

11. VMO weakness 2016-05-11 Clinical orthopaedic rehabilitation : an evidence-based approach / [edited by] S. Brent Brotzman , 3 rd ed . 11

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13. 2016-05-11 1. Sheehan FT, Borotikar BS, Behnam AJ, Alter KE. Alterations in in vivo knee joint kinematics following a femoral nerve branch block of the vastus medialis : Implications for patellofemoral pain syndrome. JCLB. Elsevier B.V; 2012 Jul 1;27(6):525–31. 13

14. 2016-05-11 1. Sheehan FT, Borotikar BS, Behnam AJ, Alter KE. Alterations in in vivo knee joint kinematics following a femoral nerve branch block of the vastus medialis : Implications for patellofemoral pain syndrome. JCLB. Elsevier B.V; 2012 Jul 1;27(6):525–31 . 14

15. Physical Exam Palpation Localized edema/tenderness Patellar glide test Lateral glide, more than 50% Patellar tilt test Lateral tilt, less than 0 degree 2016-05-11 15

16. 2016-05-11 Clinical orthopaedic rehabilitation : an evidence-based approach / [edited by] S. Brent Brotzman , 3 rd ed. 16

17. Treatment Reduction pain & inflammation Ice, NSAIDs, ultrasound, ultrasound, mobilization Address extrinsic contributing factors Reduce excessive load to patellofemoral joint Address intrinsic contributing factors Remote factors: hip muscle retraining, flexibility, foot orthoses Local factors: patellar taping, bracing, Q-ceps strengthening 2016-05-11 17

18. Orthoses Reduction of foot over-pronation Reduction of Q-angle Insoles/foot orthoses Limited evidences 2016-05-11 18

19. Patellar Taping 2016-05-11 19

20. McConnel Taping 2016-05-11 Modified from http:// youtube.com / watch?v =jBRdsK3zRyk 20

21. Patellar Brace 2016-05-11 21

22. Physical Therapy Ultrasound Laser Mobilization Manual Therapy 2016-05-11 22

23. Exercise Quadriceps Exercise Mobilization VMO retraining Biofeedback 2016-05-11 23

24. VMO Retraining 2016-05-11 Modified from https:// www.youtube.com / watch?v =S5BDi8Oj5eM 24

25. Squat vs Leg extension 2016-05-11 Modified from https:// www.youtube.com/watch?v=UXJrBgI2RxA and https:// www.youtube.com / watch?v = cfBsnDoQhEk 25

26. Sumo-Squat 2016-05-11 Modified from https:// www.youtube.com / watch?v =9ZuXKqRbT9k 26

27. Pharmacological Treatment Intra-articular glycosaminoglycan NSAIDs, Aspirin Corticosteroid Botulinum Toxin? Surgery – arthroscopic lateral release 2016-05-11 27

28. Cochrane Review (2008) 2016-05-11 Heintjes EM, Berger M, Bierma-Zeinstra SM, Bernsen RM, Verhaar JA, Koes BW. Pharmacotherapy for patellofemoral pain syndrome. 2008 28

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33. Botulinum Toxin 2016-05-11 1. PG2166. Botulinum Toxin Type A for Nonsurgical Lateral Release in Patellofemoral Pain Syndrome: A Case Study. 2011 May 19;:1–3. 33

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35. Surgery 2016-05-11 Clinical orthopaedic rehabilitation : an evidence-based approach / [edited by] S. Brent Brotzman , 3 rd ed . 35

36. Questions 2016-05-11 36 Patellofemoral Pain Syndrome Chondromalacia Patellae Patellofemoral OA ? ?

37. 2016-05-11 Clinical orthopaedic rehabilitation : an evidence-based approach / [edited by] S. Brent Brotzman , 3 rd ed . 37

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39. 2016-05-11 1. Väätäinen U, Lohmander LS, Thonar E, Hongisto T, Ågren U, Rönkkö S, et al. Markers of cartilage and synovial metabolism in joint fluid and serum of patients with chondromalacia of the patella. Osteoarthritis and Cartilage. 1998 Mar;6(2):115–24. 39

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41. 2016-05-11 1. Naslund JE, Odenbring S, Näslund U-B, Lundeberg T. Diffusely increased bone scintigraphic uptake in patellofemoral pain syndrome. British Journal of Sports Medicine. BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine; 2005 Mar;39(3):162–5. 41

42. Take Home! Patellofemoral Pain Syndrome Common cause of anterior knee pain Biomechanical problems of patella Exercise – VMO retraining Only Naproxen (VIMOVO) has evidence 2016-05-11 42

43. 감사합니다 . 43 2016-05-11