patellofemoral pain syndrome
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Patellofemoral Pain Syn-drome
2016 년 5 월 11 일재활의학과
김 종 규
05/01/2023
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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.
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Anterior Knee Pain• Patellofemoral pain syndrome
• Patellofemoral joint syndrome
• Jumper’s knee
• Chondromalacia patellae
• Peripatellar synovitis
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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
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PFPS• Sympoms
• Feeling of instability• Localized pain• Crepitus• Edema• Feeling of muscle weakness
• Cannot squat• Cannot stair up/down
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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
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Pathophysiology • Increased tension of patella to lateral side due to
• Overpronation of foot• Increased Q-angle• VMO weakness• Muscle power imbalance
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Q-angle
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Q-angle
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VMO weakness
Clinical orthopaedic rehabilitation : an evidence-based approach / [edited by] S. Brent Brotzman, 3rd ed.
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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 syn-
drome. JCLB. Elsevier B.V; 2012 Jul 1;27(6):525–31.
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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 syn-
drome. JCLB. Elsevier B.V; 2012 Jul 1;27(6):525–31.
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Physical Exam• Palpation
• Localized edema/tenderness
• Patellar glide test• Lateral glide, more than 50%
• Patellar tilt test• Lateral tilt, less than 0 degree
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Clinical orthopaedic rehabilitation : an evidence-based approach / [edited by] S. Brent Brotzman, 3rd ed.
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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 or-
thoses• Local factors: patellar taping, bracing, Q-ceps strength-
ening
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Orthoses• Reduction of foot over-pronation• Reduction of Q-angle
• Insoles/foot orthoses
• Limited evidences
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Patellar Taping
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McConnel Taping
Modified from http://youtube.com/watch?v=jBRdsK3zRyk
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Patellar Brace
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Physical Therapy• Ultrasound
• Laser
• Mobilization
• Manual Therapy
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Exercise• Quadriceps Exercise• Mobilization• VMO retraining• Biofeedback
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VMO Retraining
Modified from https://www.youtube.com/watch?v=S5BDi8Oj5eM
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Squat vs Leg extension
Modified from https://www.youtube.com/watch?v=UXJrBgI2RxA and https://www.youtube.com/watch?v=cfBsnDoQhEk
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Sumo-Squat
Modified from https://www.youtube.com/watch?v=9ZuXKqRbT9k
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Pharmacological Treatment• Intra-articular glycosaminoglycan
• NSAIDs, Aspirin
• Corticosteroid
• Botulinum Toxin?
• Surgery – arthroscopic lateral release
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Cochrane Review (2008)
Heintjes EM, Berger M, Bierma-Zeinstra SM, Bernsen RM, Verhaar JA, Koes BW. Pharmacotherapy for patellofemoral pain syndrome. 2008
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05/01/2023 1.PG2166. Botulinum Toxin Type A for Nonsurgical Lateral Release in Patellofemoral Pain Syndrome: A Case Study. 2011 May 19;:1–3.
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Botulinum Toxin
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Surgery
Clinical orthopaedic rehabilitation : an evidence-based approach / [edited by] S. Brent Brotzman, 3rd ed.
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Questions
Patellofemoral Pain Syndrome
Chondromalacia Patellae
Patellofemoral OA?
?
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Clinical orthopaedic rehabilitation : an evidence-based approach / [edited by] S. Brent Brotzman, 3rd ed.
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1. Väätäinen U, Lohmander LS, Thonar E, Hongisto T, Ågren U, Rönkkö S, et al. Markers of car-tilage and synovial metabolism in joint fluid and serum of patients with chondromalacia of the patella.
Osteoarthritis and Cartilage. 1998 Mar;6(2):115–24.
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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.
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Take Home!• Patellofemoral Pain Syndrome
• Common cause of anterior knee pain
• Biomechanical problems of patella
• Exercise – VMO retraining
• Only Naproxen (VIMOVO) has evidence
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감사합니다 .
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