Patella Femoral Pain Syndrome

Patient Presentation No: 3Dr G Coetzer1999061854

PATIENT DETAILS

• Girl• 13 years old• S.A Swimmer• Recently started playing hockey

COMPLAINT

• Pain in right knee• Aggravated by:

» Running» Climbing stairs» Squatting

FURTHER HISTORY

• No history of injury/trauma• No medical history• No previous problems with exercise

– What changed?– Started playing hockey

CLINICAL EXAMINATION• Ligaments

» Intact

• Cartilage» Negative grind test

CLINICAL EXAMINATION(Continued)

• Extrinsic Factors» Increased repetition» Astro Turf» Hockey shoes

CLINICAL EXAMINATION(Continued)

• Intrinsic Factors» Increased sub-talor pronation» Reduced muscle bulk of Vasti » Lateral patella tilt

BIOMECHANICAL

• Q angle not increased• Increased Sub-talor pronation• Patella lateral tilt

3 STAGE SUMMARY

CLINICAL

• 13 year old girl with patella femoral pain of right knee

PERSONAL

• Worried about performance with swimming as well as popularity with pupils who play hockey

CONTEXTUAL

• 13 year old girl with pain of the right knee with the diagnosis of patella femoral pain syndrome

PROBLEM LIST

• Active» To maintain fitness relatively pain free

• Passive» To correct bad biomechanical and Vasti

weakness

PLAN

• Reduce Inflammation» Taping» NSAIDS

• Addressing the Extrinsic Factors» Better shoes» Arch support

• Addressing Intrinsic Factors» Strengthening of the Vasti, especially

Vastus Medialus» Soft tissue therapy/stretching to decrease

lateral tightness

DISCUSSION

• Umbrella term used to describe pain around the patella

• Very common specially in female runners

• Usually starts in adolescence

FACTORS THAT CONTRIBUTE TO PATELLA FEMORAL PAIN

• Extrinsic Factors• Intrinsic Factors

EXTRINSIC FACTORS

• Body Mass• Speed at gait• Contact with the ground• Foot wear• Also with an increase in knee flexion

INTRINSIC FACTORS

• Factors that influence the load on the patella femoral joint– Remote Factors– Local Factors

INTRINSIC FACTORS(Continued)

• Remote Factors» Increased femoral internal rotation» Increased knee valgus» Increased tibial rotation» Increased Subtalar pronation» Inadequate flexibility

INTRINSIC FACTORS(Continued)

• Local Factors» Patella position» Soft tissue contributions» Neuromuscular control of the vasti

TREATMENT OF PATELLA FEMORAL PAIN SYNDROME

• Requires an integrated approach

AIMS OF TREATMENT

• Reduction of pain and inflammation» NSAIDS» Taping » Bracing

• Addressing Extrinsic Factors• Addressing Intrinsic Factors

» Strengthening of the vasti and hip abductors» Stretching» Mobilisation of the patella

LESSON

• Patella Femoral Pain Syndrome has multiple aetiology

• Good history and clinical examination is essential in diagnosing patella femoral pain syndrome

• Treatment is a team approach involving the physio, trainer, doctor, patient, and sometimes orthopaedic specialist

REFERENCES

• Clinical Sports Medicine, Third Edition– Peter Brukner and Karim Khan

• Anatomy of Huma Movement Structure and Funciton, Fifth Edition– Nigel Palastanga, Derek Field, Roger Soames

• The American Journal of Sports Medicine– AMJ Sports Med 2010 38: 1626 originally published

online May 26 2010

• BMJ Research– Cite this as: BMJ 2009;339;b4074

doi:10.1136/bmj.b4074