Last reviewed: 10 Nov 2024
Last updated: 10 Mar 2023
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
Full details
Risk factors
- bony and structural abnormalities
- iliotibial band tightness
- abnormal patellar mobility
- quadriceps muscle weakness
- subtalar joint pronation
- hip internal rotation
- gait deviations
Full details
Diagnostic tests
1st tests to order
- no initial test
Full details
Tests to consider
- knee x-ray
- MRI
- kinematic MRI or CT
Full details
Treatment algorithm
INITIAL
acute pain
ACUTE
abnormal patellofemoral joint mechanics
lower kinetic chain problems
overuse in athletes
ONGOING
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
Disclosures
JH declares that he has no competing interests.
Differentials
- Iliotibial band syndrome
- Plica syndrome
- Patellar tendonitis/tendinopathy
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