2018년 11월 18일 일요일

Patellofemoral pain and patellar tendinopathy

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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