Patellofemoral pain syndrome (PFPS) , also known as runner knee , is a condition characterized by knee pain ranging from severe to mild discomfort that appears to be from the posterior contact surface of the patella (back of kneecap) with the femur (thigh bone). This is "anterior knee pain involving patellas and retinaculum that exclude intra-articular pathology and other elephants".
The most at-risk populations of PFPS are runners, cyclists, basketball players and other sports participants. Onset may gradually or result from a single incident and is often caused by changes in the training regime that include a dramatic increase in training time, distance or intensity, may be exacerbated by the type of shoe used or the wrong one. Symptoms include discomfort when sitting with knees bent or down stairs and general knee pain. Treatment involves rest and physical therapy that includes stretching exercises and strengthening for the feet.
Video Patellofemoral pain syndrome
Signs and symptoms
The onset of the condition is usually gradual, although some cases may appear suddenly after trauma.
- Knee pain - the most common symptoms are diffuse peripatelic pain (faint pain around the kneecap) and localized retropatial pain (focused pain behind kneecap). Affected individuals usually have difficulty describing the location of the pain, and may place their hands on the anterior patella or draw a circle around the patella ("circle sign"). Pain usually begins when the load is placed on the extensor mechanism of the knee, such as up or down stairs or slopes, squatting, kneeling, cycling, running or sitting with knees bent (bent). The last feature is sometimes called a "movie sign" or "theatrical mark" because individuals may experience pain while sitting to watch a movie or similar activity. The pain is usually painful occasionally.
- Crepitus (the sound of a joint) may exist
- Giving a knee path can be reported
Maps Patellofemoral pain syndrome
Cause
In most patients with PFPS, their history checks will highlight the triggering events that cause injury. Changes in activity patterns such as excessive increase in running distance, repetitions such as running steps and the addition of strength training that affects the patellofemoral joint are commonly associated with symptom onset. Too worn footwear may be a contributing factor. To prevent the recurrence of causal behavior must be identified and managed properly.
The medical cause of PFPS is suspected of increased pressure on the patellofemoral joint. There are several theorizing mechanisms related to how this pressure increase occurs:
- Increased physical activity level
- Malasignment of the patella as it travels through the femoral groove
- Quadriceps muscle imbalance
- Strict anatomical structure, e.g. retinaculum or iliotibial band.
Causes of pain and dysfunction often occur due to abnormal forces (eg increased lateral quadriceps reticulum drips with acute or chronic lateral PF subluxation/dislocation) or prolonged repetitive or transient or shear forces (running or jump) in the PF joint. The result is synovial irritation and inflammation and subcondral bone changes in the distal femur or patella known as "bruised bone". Secondary causes PF syndrome is fracture, internal knee damage, knee osteoarthritis and bone tumor in or around the knee.
Diagnosis
Checkout
The patient can be observed standing and walking to determine patellar alignment. The Q angle, lateral hypermobility, and the commonly used J sign are determined to determine the patellar maltracking. The glide, tilt, and grind patellofemoral test, when performed, can provide strong evidence for PFPS. Finally, lateral instability can be assessed through patellar apprehension testing, which is considered positive when there is pain or discomfort associated with patellar lateral translation.
Differential diagnosis
The diagnosis of patellofemoral pain syndrome is made by overriding patellar tendinitis, prepatellar bursitis, plica syndrome, Sinding-Larsen syndrome and Johansson, and Osgood-Schlatter's disease.
Classification
Knee Runner
PFPS is one of several conditions sometimes referred to as the runner's knee; Other conditions are Chondromalacia patellae, Iliotibial band syndrome, and Plica syndrome.
Chondromalacia patellae
Chondromalacia patellae is a term sometimes treated synonymously with PFPS. However, there is general consensus that PFPS applies only to individuals without cartilage damage, thus distinguishing it from chondromalacia patellae, a condition characterized by softening of the patellar articular cartilage. Despite these academic differences, PFPS diagnosis is usually made clinically, based only on history and physical examination rather than on medical imaging results. Therefore, it is unknown whether most people with a PFPS diagnosis have cartilage damage or not, making the distinction between PFPS and theoretical chondromalacia rather than practical. It is thought that only a few individuals with anterior knee pain have true chondromalacia patellae.
Treatment
As patellofemoral pain syndrome is the most common cause of anterior knee pain in outpatients, various treatments for patellofemoral pain syndrome are implemented. Most patients with patellofemoral pain syndrome respond well to conservative therapy.
Exercise
There is consistent but very low quality evidence that exercise therapy for PFPS reduces pain, improves function and helps long-term recovery. However, there is insufficient evidence to compare the effectiveness of different types of exercise with each other, and exercise with other forms of treatment.
Exercise therapy is PFPS recommended first line treatment. Various exercises have been studied and recommended. Exercises are described according to 3 parameters:
- Type of muscle activity (concentric, eccentric or isometric)
- Type of shared movement (dynamic, isometric or static)
- Reaction force (closed or open kinetic chain)
The majority of exercise programs intended to treat PFPS are designed to strengthen the quadriceps muscle. Strengthening quadriceps is considered a standard "gold" treatment for PFPS. Strengthening quadriceps is generally recommended because the quadriceps muscle helps stabilize the patella. Weaknesses of quadriceps and muscle imbalance may contribute to abnormal patellar tracking.
If the muscle strength of the medial vastus is inadequate, the lateral muscle of the laterus is usually larger and stronger it will pull sideways (laterally) on the kneecap. Strengthening the vastus medial to prevent or resist lateral vastus lateralis is one way to eliminate PFPS. Moderate evidence supports the addition of pelvic abductors and external rotator reinforcement, as well as exercises that target hip flexion and hip extension.
Emphasis during exercise can be placed on the coordinated contraction of the medial and lateral portions of the quadriceps as well as from the hip adductor, hip kidnapper and gluteal muscle. Many exercise programs include stretches designed to increase flexibility of the lower extremities. Biofeedback electrophyography allows visualization of specific muscle contractions and can help individuals perform exercises to target the intended muscles during exercise. Electrostimulation can be used to apply external stimuli which result in contraction of certain muscles and thus exercise.
Inflexibility is often referred to as a source of patellofemoral pain syndrome. Stretching the knee laterial has been suggested to help.
Medication
Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to treat PFPS, but there is only very limited evidence that they are effective. NSAIDs can reduce pain in the short term, but overall, after three months, the pain does not improve. There is no evidence that one type of NSAID is superior to the others in PFPS, and therefore some authors recommend that NSAIDs with the fewest side effects and which are the cheapest should be used.
Glycosaminoglycan polysulfate (GAGPS) inhibits proteolytic enzymes and increases the synthesis and degree of hyaluronic acid polymerization in synovial fluid. There is contradictory evidence that it is effective in PFPS.
Medical description
Rare magnetic resonance imaging can provide useful information for managing patellofemoral pain syndrome and treatment should focus on appropriate rehabilitation programs including fixing strength and flexibility issues. In rare cases where the patient has mechanical symptoms such as locked knee, knee effusion, or failure to improve the following physical therapy, MRI may provide more insight into diagnosis and treatment.
Rest
The patellofemoral pain syndrome can also occur due to excessive use or PF joint overload. For this reason, knee activity should be reduced until pain is resolved.
Braces and taping
There were no statistically or clinically significant differences in pain symptoms between taping and non-taping in individuals with PFPS.
Knee amplifier is not effective in treating PFPS. The McConnell recording technique involves the withdrawal of the medial patella with the tape (medial glide). Findings from several studies indicate that there is limited benefit with tapet or brace patella when compared to quadriceps exercise alone.
Foot orthoses
The low arch may cause overpronation or the foot rolls into too much of a burden on the patellofemoral joint. Poor lower extremity biomechanics can cause stress on the knee and may be associated with the development of patellofemoral pain syndrome, although the exact mechanisms linking joint loading to the development of the condition are unclear. Foot Orthosis may help improve lower extremity biomechanics and can be used as an overall care component. Foot orthoses may be useful for reducing knee pain in the short term, and can be combined with exercise or physical therapy programs.
Surgery
The scientific consensus is that surgery should be avoided except in very severe cases where conservative care fails. The majority of individuals with PFPS receive non-surgical treatment.
Alternative medicine
There is no evidence to support the use of acupuncture, low-level laser therapy, to treat PFPS. Most research touting the benefits of alternative therapies for PFPS is done with a defective experimental design, and therefore does not produce reliable results.
Epidemiology
Specific populations at high risk of primary PFPS include runners, cyclists, basketball players, young athletes and women.
See also
- Plica syndrome
- Iliotibial Band Syndrome
References
External links
- Patellofemoral pain syndrome in Curlie (based on DMOZ)
- Joint Patricofemoral Syndrome Treatment & amp; Management in eMedicine
Source of the article : Wikipedia
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