Comparison of the clinical features of patellofemoral pain and patellar tendinopahty
(슬개대퇴증후군과 슬개건병증의 임상적 비교)
Signs
|
Patellofemoral pain
|
Patellar tendinopathy
|
Onset
|
Running (especially downhill), Steps/stairs, hills
Any weight-bearing activities involving knee flexion(e.g. distance running)
|
Activities involving jumping and/or changing
direction(e.g. basketball, volleyball, high jump, netball, bounding, ballet,
climbing stairs)
|
pain
|
Non-specific or vague May be medial, lateral or
infrapatellar, Aggravated by activities that load the Patellofemoral joint
|
Usually at the inferior pole of patella,
Aggravated by jumping and early-to mid squat
|
Inspection
|
Generally normal or VMO wasting
|
Generalized quadriceps wasting
|
Tenderness
|
Usually medial or lateral facets of patella May be
tender in infrapatellar region.
May have no pain on palpation due to areas of
patella being inaccessible
|
Commonly inferior pole of patellar tendon attachment.
Occasionally at distal attachment to tibial
tuberosity.
Rarely in midtendon
|
swelling
|
May have small effusion with either suprapatellar or
infrapatellar swelling
|
Rare
Tendon may be increased in thickness
|
Clicks/clunks
|
Occasional
|
No
|
Crepitus
|
Occasionally under patella
|
No
|
Giving way
|
Due to subluxation of (occasionally) quadriceps
inhibition
|
Occasionally due to quadriceps inhibition
|
Knee range of motion
|
Usually normal
May be decreased in severe cases
|
Usually normal
No pain with overpressure
|
Quadriceps contraction in extension
|
Note quality of movement
Usually not painful
|
Some cases are painful
|
Patellofemoral joint movement
|
May be restricted in any direction.
Commonly restricted medial glide due to tight
lateral structures.
|
May have normal patellofemoral joint biomechanics,
in combined problem will have patellofemoral joint signs
|
Vastus medialis obliquus
|
May have obvious wasting, weakness, or more subtle
deficits in tone and timing
|
May have generalized quadriceps weakness
|
Functional testing
|
Squats, stairs may aggravate.
Patellofemoral joint taping should decrease pain
|
Decline squats aggravate pain.
Patellofemoral taping has less effect
|
Ref) Clinical sport medicine P 682
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