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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