Patellofemoral pain syndrome
Summary
Definition
History and exam
Key diagnostic factors
- ill-defined ache
- pain aggravated by compressive force
- Q angle
- pain on palpation of patellar retinaculum
- patellar tilt test
- mediolateral glide test
- patellar mobility test
- patellar apprehension test
- patellar maltracking test
- decreased muscle flexibility
- muscle weakness
Risk factors
- bony and structural abnormalities
- iliotibial band tightness
- abnormal patellar mobility
- quadriceps muscle weakness
- subtalar joint pronation
- hip internal rotation
- gait deviations
Diagnostic tests
1st tests to order
- no initial test
Tests to consider
- knee x-ray
- MRI
- kinematic MRI or CT
Treatment algorithm
acute pain
abnormal patellofemoral joint mechanics
lower kinetic chain problems
overuse in athletes
post initial and reactivation-phase treatment
Contributors
Authors
Michael Fredericson, MD, FACSM
Associate Professor and Director
Physical Medicine & Rehabilitation Clinics
Stanford University
Stanford
CA
Disclosures
MF declares that he has no competing interests.
Acknowledgements
Dr Michael Fredericson would like to gratefully acknowledge Dr Jong In Lee and Dr Julia Arroyo, previous contributors to this topic. JIL and JA declare that they have no competing interests.
Peer reviewers
John Cianca, MD
Clinical Associate Professor
Department of Physical Medicine & Rehabilitation
Baylor College of Medicine
Houston
TX
Disclosures
JC declares that he has no competing interests.
John Halperin, MD
Physician
Sharp Rees-Stealy Medical Group
La Mesa
San Diego
CA
Declarações
JH declares that he has no competing interests.
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Declarações
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Referências
Principais artigos
Fredericson M, Powers CM. Practical management of patellofemoral pain. Clin J Sport Med. 2002;12:36-38. Resumo
Earl JE, Vetter CS. Patellofemoral pain. Phys Med Rehabil Clin N Am. 2007;18:439-458,viii. Resumo
Fredericson M, Yoon K. Physical examination and patellofemoral pain syndrome: a review. Am J Phys Med Rehabil. 2006;85:234-243. Resumo
American College of Radiology. ACR Appropriateness Criteria. Chronic knee pain. 2018 [internet publication].Texto completo
Collins NJ, Bisset LM, Crossley KM, et al. Efficacy of nonsurgical interventions for anterior knee pain: systematic review and meta-analysis of randomized trials. Sports Med. 2012;42:31-49. Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Iliotibial band syndrome
- Plica syndrome
- Patellar tendonitis/tendinopathy
Mais Diagnósticos diferenciais
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