patellofemoral pain syndrome
TRANSCRIPT
![Page 1: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/1.jpg)
Patellofemoral Pain Syn-drome
2016 년 5 월 11 일재활의학과
김 종 규
![Page 2: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/2.jpg)
05/01/2023
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.
![Page 3: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/3.jpg)
05/01/2023
3
Anterior Knee Pain• Patellofemoral pain syndrome
• Patellofemoral joint syndrome
• Jumper’s knee
• Chondromalacia patellae
• Peripatellar synovitis
![Page 4: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/4.jpg)
05/01/2023
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
![Page 5: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/5.jpg)
05/01/2023
5
PFPS• Sympoms
• Feeling of instability• Localized pain• Crepitus• Edema• Feeling of muscle weakness
• Cannot squat• Cannot stair up/down
![Page 6: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/6.jpg)
05/01/2023
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
![Page 7: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/7.jpg)
05/01/2023
7
Pathophysiology • Increased tension of patella to lateral side due to
• Overpronation of foot• Increased Q-angle• VMO weakness• Muscle power imbalance
![Page 8: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/8.jpg)
05/01/2023
8
![Page 9: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/9.jpg)
05/01/2023
9
Q-angle
![Page 10: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/10.jpg)
05/01/2023
10
Q-angle
![Page 11: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/11.jpg)
05/01/2023
11
VMO weakness
Clinical orthopaedic rehabilitation : an evidence-based approach / [edited by] S. Brent Brotzman, 3rd ed.
![Page 12: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/12.jpg)
05/01/2023
12
![Page 13: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/13.jpg)
05/01/2023
13
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.
![Page 14: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/14.jpg)
05/01/2023
14
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.
![Page 15: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/15.jpg)
05/01/2023
15
Physical Exam• Palpation
• Localized edema/tenderness
• Patellar glide test• Lateral glide, more than 50%
• Patellar tilt test• Lateral tilt, less than 0 degree
![Page 16: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/16.jpg)
05/01/2023
16
Clinical orthopaedic rehabilitation : an evidence-based approach / [edited by] S. Brent Brotzman, 3rd ed.
![Page 17: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/17.jpg)
05/01/2023
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 or-
thoses• Local factors: patellar taping, bracing, Q-ceps strength-
ening
![Page 18: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/18.jpg)
05/01/2023
18
Orthoses• Reduction of foot over-pronation• Reduction of Q-angle
• Insoles/foot orthoses
• Limited evidences
![Page 19: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/19.jpg)
05/01/2023
19
Patellar Taping
![Page 20: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/20.jpg)
05/01/2023
20
McConnel Taping
Modified from http://youtube.com/watch?v=jBRdsK3zRyk
![Page 21: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/21.jpg)
05/01/2023
21
Patellar Brace
![Page 22: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/22.jpg)
05/01/2023
22
Physical Therapy• Ultrasound
• Laser
• Mobilization
• Manual Therapy
![Page 23: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/23.jpg)
05/01/2023
23
Exercise• Quadriceps Exercise• Mobilization• VMO retraining• Biofeedback
![Page 24: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/24.jpg)
05/01/2023
24
VMO Retraining
Modified from https://www.youtube.com/watch?v=S5BDi8Oj5eM
![Page 25: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/25.jpg)
05/01/2023
25
Squat vs Leg extension
Modified from https://www.youtube.com/watch?v=UXJrBgI2RxA and https://www.youtube.com/watch?v=cfBsnDoQhEk
![Page 26: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/26.jpg)
05/01/2023
26
Sumo-Squat
Modified from https://www.youtube.com/watch?v=9ZuXKqRbT9k
![Page 27: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/27.jpg)
05/01/2023
27
Pharmacological Treatment• Intra-articular glycosaminoglycan
• NSAIDs, Aspirin
• Corticosteroid
• Botulinum Toxin?
• Surgery – arthroscopic lateral release
![Page 28: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/28.jpg)
05/01/2023
28
Cochrane Review (2008)
Heintjes EM, Berger M, Bierma-Zeinstra SM, Bernsen RM, Verhaar JA, Koes BW. Pharmacotherapy for patellofemoral pain syndrome. 2008
![Page 29: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/29.jpg)
05/01/2023
29
![Page 30: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/30.jpg)
05/01/2023
30
![Page 31: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/31.jpg)
05/01/2023
31
![Page 32: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/32.jpg)
05/01/2023
32
![Page 33: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/33.jpg)
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.
33
Botulinum Toxin
![Page 34: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/34.jpg)
05/01/2023
34
![Page 35: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/35.jpg)
05/01/2023
35
Surgery
Clinical orthopaedic rehabilitation : an evidence-based approach / [edited by] S. Brent Brotzman, 3rd ed.
![Page 36: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/36.jpg)
05/01/2023
36
Questions
Patellofemoral Pain Syndrome
Chondromalacia Patellae
Patellofemoral OA?
?
![Page 37: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/37.jpg)
05/01/2023
37
Clinical orthopaedic rehabilitation : an evidence-based approach / [edited by] S. Brent Brotzman, 3rd ed.
![Page 38: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/38.jpg)
05/01/2023
38
![Page 39: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/39.jpg)
05/01/2023
39
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.
![Page 40: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/40.jpg)
05/01/2023
40
![Page 41: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/41.jpg)
05/01/2023
41
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.
![Page 42: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/42.jpg)
05/01/2023
42
Take Home!• Patellofemoral Pain Syndrome
• Common cause of anterior knee pain
• Biomechanical problems of patella
• Exercise – VMO retraining
• Only Naproxen (VIMOVO) has evidence
![Page 43: Patellofemoral Pain Syndrome](https://reader035.vdocuments.mx/reader035/viewer/2022070515/587acf251a28ab760f8b6539/html5/thumbnails/43.jpg)
43
05/01/2023
감사합니다 .