CC Patellofemoral Pain Syndrome

echoecho's version from 2017-03-20 01:00


Question Answer
Define Patellofemoral Pain Syndrome (PFPS)?A major cause of knee pain that, although associated with sports or exercise, is usually NOT associated with a specific, acute injury
It is reported to be the most common cause of knee pain evaluated in a primary care setting and is more common in what gender?Women and girls
What physical signs and symptoms indicated the diagnosis of PFPS?1) slightly overweight female including pain after prolonged sitting ("movie goer sign"). 2) lack of meniscal or ligament findings. 3) decreased popliteal angle
Patients with PFPS complain of insidious onset of _____ knee pain in one or both knees that occurs with ______ and may increase when descending ____ or running on ____ terrain?1) anterior. 2) activity 3) steps. 4) terrain
Prolonged sitting may also trigger the pain which may occur while what?The patient is still sitting and/or immediately upon rising with movement
Patient might have a hx of increased _____ time or may engage in activities that cause ____ forces of the knee?1) training. 2) twisting
Is there any hx of high velocity trauma or an acute injury?No
If there is a hx of an acute injury precip;tasting pain, suspicion of _____ injury should be raised?Cartilage
In PFPS, ____ and ____ ROM should be normal but may cause pain?Active; passive
Additionally, assuming the ____ position may be painful and elicit creditable?Squat
What is the cause of PFPS?Not clear but is probably multi factorial
Why is the patella a biomechanics like complex that is more complicated than often thought?It moves up and down as the lower leg is flexed and extended and it also tilts and rotates and this mono lament across numerous points of contact between the undersurface of the patella and the femur is thought to be one of the causes of pain, especially if there is a hx of misuse, overuse or malalignment
What is a Q angle?Defined as the acute angle formed by the intersection of a line drawn from the anterior inferior iliac spine and the center of the patella and a line from the tibial tubercle to the same pint on the patella
What is the normal degrees of the Q angle in men? In women?14 degrees; 17 degrees
Why have recent authors minimized the Q angle abnormalities?Because barring surgical correction, an abnormal Q angle is NOT a modifiable factor
If PFPS is suspected, is radiologic imaging at the initial visit necessary?No
When is imaging considered?When the hx and physical suggest an alternative dx or if unusual conditions (such as osteochondritis dis secant, infection or neoplasm are suspected, especially if there is NO response to treatment in a compliant patient within 6 weeks or so)
Though the term chondromalacia has been used in the past to describe PFPS, it is no recommended to use this term ONLY in patients who show _____ softening at surgery?Cartilage
Define chondromalacia?Is a surgical finding that describes abnormal areas of hyaline cartilage caused by trauma or aberrant loading
Is an MRI needed in the evaluation of PFPS?Rarely, unless the exam suggests other etiologies
Is there general consensus on the treatment of PFPS?1) there is no general consensus. 2) treatment should be individualized, guided by the information collected by the hx and physical exam no directed at the suspected cause of the problem, which is usually multi factorial
What medication can be used?NSAIDs (they reduce pain for a brief period and allow patients to pursue rehabilitation)
Patients who are treated with NSAIDs and rest alone have a high rate of recurrence, why?Because these interventions do NOT address strength and flexibility problems
Is the use of orthotic devices for treating PFPS controversial?Yes
*** A 2015 Cochran review found a lack of evidence supporting recommendations for use of knee ______ to reduce pain in conjunction with an exercise program? List examples of these recommendations?1) orthotics. 2)braces, sleeves, straps, bandages)
Why should orthotic devices be reserved for patients who have NOT responded to flexibility and strengthening routines?Because of the lack of supporting evidence and the cost of orthotic devices
In another Cochrane review, ____ therapy was not shown to have a clinically important effect on pain relief?Ultrasound
What is the mainstay of PFPS?Physical therapy and correction of muscle imbalances
*** Strengthening of ____ _____ and ______ should be the primary target with additional efforts to correct any muscle imbalance detected during physical exam?Hip abductors; quadriceps
Patients can often perform physical therapy on their own in ___ minute per day sessions, though referral to a physical therapist for muscle strength testing and guidance for therapy can be helpful?20
Patients should be told they may not experience improvement for ___ weeks or longer, and the syndrome may recur?6
____ for PFPS is considered a last resort?Surgery
In general, PFPS has a good prognosis with resolution over time, true of false?True
Recommendations regarding return to activities that may have contributed to PFPS must be individualized based on what?1) pain status. 2) evaluation of the effectiveness of corrective measures
*** SUMMARY = PFPS is a common knee syndrome with uncertain etiology that more commonly seen in what gender?Women and girls
*** SUMMARY = Evaluation is by doing what? Are imaging studies needed?1) hx and physical examination. 2) no
*** SUMMARY = Treatment is what?physical therapy that includes strengthening of the hip abductors and quadriceps and may be supplemented by short-term anti-inflammatories for symptom relief
*** SUMAMRY = Evidence for the benefit of other modalities such as therapeutic _____, bracing, straps and supports is poor and of low quality?ultrasound