An Investigation of Differential Diagnosis of Patellofemoral Pain Syndromes Shannon Marie Buckmier University of North Dakota
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University of North Dakota UND Scholarly Commons Physical Therapy Scholarly Projects Department of Physical Therapy 1995 An Investigation of Differential Diagnosis of Patellofemoral Pain Syndromes Shannon Marie Buckmier University of North Dakota Follow this and additional works at: https://commons.und.edu/pt-grad Part of the Physical Therapy Commons Recommended Citation Buckmier, Shannon Marie, "An Investigation of Differential Diagnosis of Patellofemoral Pain Syndromes" (1995). Physical Therapy Scholarly Projects. 81. https://commons.und.edu/pt-grad/81 This Scholarly Project is brought to you for free and open access by the Department of Physical Therapy at UND Scholarly Commons. It has been accepted for inclusion in Physical Therapy Scholarly Projects by an authorized administrator of UND Scholarly Commons. For more information, please contact [email protected]. AN INVESTIGATION OF DIFFERENTIAL DIAGNOSIS OF PATELLOFEMORAL PAIN SYNDROMES by Shannon Marie Buckmier Bachelor of Science in Physical Therapy University of North Dakota, 1994 An Independent Study Submitted to the Graduate Faculty of the Department of Physical Therapy School of Medicine University of North Dakota in partial fulfillment of the requirements for the degree of Master of Physical Therapy Grand Forks, North Dakota May 1995 This Independent Study, submitted by Shannon Marie Buckmier in partial fulfillment of the requirements for the Degree of Master of Physical Therapy from the University of North Dakota, has been read by the Faculty Preceptor, Advisor, and Chairperson of Physical Therapy under whom the work has been done and is hereby approved. \~yy\-es ~~ (Graduate School Advisor) (Chairperson, Physical Therapy) 11 PERMISSION Tilte An Investigation of Differential Diagnosis of Patellofemoral Pain Syndromes Department Physical Therapy Degree Master of Physical Therapy In presenting this Independent Study Report in partial fulfillment of the requirements for a graduate degree from the University of North Dakota, I agree that the Department of Physical Therapy shall make it freely available for inspection. I further agree that permission for extensive copying for scholarly purposes may be granted by the professor who supervised my work or, in her absence, by the Chairperson of the department. It is understood that any copying or publication or other use of this Independent Study Report or part thereof for financial gain shall not be allowed without my written permission. It is also understood that due recognition shall be given to me and the University of North Dakota in any scholarly use which may be made of any material in my Independent Study Report. · () A A'1 A-?'I ;/1" SIgnature"'i'~,,-,-d__ '_I/,t.-G'_,_ I_& __~ ~ __ "","",~J Date I ~/ls-/9~ 111 TABLE OF CONTENTS TITLE PAGE...................................................................................................... ........i APPROVAL P AGE .................................................................................................... ii PERMISSION P AGE ................................................................................................ .iii ACKNOWLEDGEMENTS ........................................................................................ v ABSTRACT ................................................................................................................ vi CHAPTER ONE: INTRODUCTION ........................................................................ 1 CHAPTER TWO: ANATOMY, FUNCTION, AND BIOMECHANICS ................ .3 CHAPTER THREE: PLICA SYNDROME .............................................................. 10 CHAPTER FOUR: CHONDROMALACIA PATELLAE ........................................ 16 CHAPTER FIVE: PATELLAR TRACKING ...........................................................22 CHAPTER SIX: PATELLAR INSTABILITIES: SUBLUXATIONS & DISLOCATIONS ............................................................................... 26 CHAPTER SEVEN: CONCLUSION ....................................................................... 31 APPENDIX ................................................................................................................ 38 REFERENCES ........................................................................................................... 34 ACKNOWLEDGMENTS I would like to sincerely thank Peg Mohr, PhD, for all her efforts with the preparation of this independent study. I would also like to express my gratitude to everyone in the Physical Therapy Department at the University of North Dakota for all their support throughout the past three years. I would like to thank my friends, relatives, and especially my parents for their never ending love, encouragement, and support over the years. I hope that I will always be there for them as they were for me. I would also like to dedicate this manuscript to my Grandmother who passed away this last August. ABSTRACT Dysfunction of the patellofemoral j oint has long been a topic of discussion and debate for caregivers of patients with this syndrome. Various diagnosis related to the patellofemoral j oint of the knee have been reported. Patellofemoral pain refers to the clinical presentation of pain in the anterior region of the knee. It is one of the most common musculoskeletal complaints in children, adolescents, and adults. It is a major source of pain and dysfunction in both genders, but is more common in females. The purpose of this literature review is to help distinguish between several differential diagnosis included as part of patellofemoral pain syndromes. These include plica syndrome, chondromalacia patellae, extensor mechanism or tracking problems, and instability problems of subluxation and dislocations. Aspects of each of the above conditions will be discussed in the manner of definition, presentation, clinical signs and symptoms, and special tests specific to each syndrome along with a brief diagnosis and treatment for each condition. I will conclude my findings by comparing and contrasting each condition. CHAPTER ONE INTRODUCTION Dysfunction of the patellofemoraljoint has long been a topic of discussion and debate for caregivers of patients with this syndrome. Various diagnosis related to the patellofemoraljoint and the extensor mechanism of the knee have been reported. I Patellofemoral pain refers to the clinical presentation of pain in the anterior region of the 2 5 knee. ,3,4 Patellofemoral pain is the most common symptom complex in the knee joint and is one of the most common musculoskeletal complaints in children, adolescents, and adults.3 It is a major source of pain and dysfunction in both genders,6,7 but is found to be 8 more common in females. ,9,10 It afflicts not only the athletic population but sedentary individuals as well.6,7 ShellocklO stated that approximately 30% of exertion-related injuries in athletes involve the patellofemoral joint; and in some active populations such as runners, the patellofemoral joint is the most frequently injured joint. 10,1 I These patients often present with nonspecific signs and symptoms of varying degrees. The exact source of patellofemoral pain cannot always be determined and it is diagnosed as "anterior knee pain." The knee joint is made up of articular cartilage which does not contain pain receptors. Therefore, the relationship between cartilage degeneration and pain is inconsistent.6 These conditions are often frustrating for the patient4 as well as the caregiver.3 The precipitating events, the location and duration of 1 2 the pain are all important factors in narrowing the differential diagnosis, as are a detailed 3 history and physical examination. ,7 The purpose of this literature review is to help distinguish between several differential diagnosis included as part of patellofemoral pain syndromes. These include plica syndrome, chondromalacia patellae, extensor mechanism or tracking problems, and instability problems of subluxation and dislocations. Aspects of each of the above conditions will be discussed in the following manner: definition, presentation, clinical signs and symptoms, and special tests specific to each syndrome along with a brief diagnosis and treatment for each. I will conclude my findings by comparing and contrasting each condition. CHAPTER TWO ANATOMY, FUNCTION AND BIOMECHANICS This chapter will focus on the anatomy, function, and biomechanics of the knee. An understanding of these factors is of primary importance when trying to distinguish between patellofemoral pain syndromes of plica, chondromalacia patellae, tracking, and instability problems. The human knee is the largestl2 and most complex joint in the body.13 It is formed during the fourth month of embryologic development. 14,15 The knee joint is comprised of the tibiofemoral and patellofemoral joints.12 The tibiofemoral joint is the largest hinged joint in the body,16 formed by the two longest bones of the body, the femur and the tibia, therefore, an enormous amount of stress may be placed upon the knee joint. The long lever arms of the femur and tibia produce an increased mechanical advantage which places the knee joint at an increased risk ofinjuryy,16 Stability of this joint depends on the strength of all the muscles and ligaments attached to the joint. 13,16 Tibiofemoral motion occurs through rolling and gliding. During flexion, rolling is illustrated by the contact point of the tibia moving posteriorly. Gliding occurs because the contact point on the femur moves a greater distance than the contact point on the tibia. Along