1 / 19

Patellofemoral Joint Assessment

Patellofemoral Joint Assessment. Chapter 7, p. 244. Clinical Anatomy p. 244-245. Sesamoid Bone Patellar Facets: medial, lateral, odd (Table 7-1, p. 245) Joint Reaction Forces Retinacula Patellofemoral ligaments Bursa. Patellar Movement.

eyad
Download Presentation

Patellofemoral Joint Assessment

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Patellofemoral Joint Assessment Chapter 7, p. 244

  2. Clinical Anatomyp. 244-245 • Sesamoid Bone • Patellar Facets: • medial, lateral, odd (Table 7-1, p. 245) • Joint Reaction Forces • Retinacula • Patellofemoral ligaments • Bursa

  3. Patellar Movement • 135 – 45 degrees extension: firmly seated within condyles of femur • 45 – 18 degrees: medially • 18 – 0 degrees: laterally • Greatest amount of facet contact with condyles occurs between 60 – 90 degrees of flexion

  4. Joint Reaction Forces • As the flexes, so does the PFJRF • Quadriceps Torque during • Level walking – 0.5 X BW • Stair climbing = 3-4 X BW • Squat position = 7-8 X BW Pressure = Force (body weight)/Area

  5. Muscular Anatomyp. 245 • Quadriceps • VM:VL relationship • Quad:HS relationship • Triceps surae involvement •  PF pronation   tibial rotation  improper tracking • Edema & Muscle Recruitment • 20-30 cc's cause inhibition of VM (50-60 cc's to impair extensor mechanism)

  6. History—p. 246 • Mechanism/Onset • Acute: fractures or contusions • Chronic: overuse syndromes, Chondromalacia (Box 7-1, p. 247) • Theater Sign • ”Locking” vs Clicking/Grinding • “Giving Way” • Referred pain patterns • Changes in activity level • PMH/Surgeries

  7. Inspection—p. 247 • Full extension: • Centered on femur • Inferior pole @joint line • Malalignments: • (Box 7-2, p. 248) • Patella length/size • Knee posture: valgum, varum, recurvatum • Leg Length Difference? • Foot deformities

  8. Patella Abnormalities • Patella Alta: when the patellar tendon is 20% longer than the patella. Common in females. Usually seen with a tight rectus femoris • Patella Baja: when the tendon is 20% shorter than the patella. Sometimes a result of a PTG ACL reconstruction

  9. Inspection: Q Anglep. 249, 250 • Box 7-3, p. 250 • Measured in full ext. • Measure angle from ASIS to patella to tibial tuberosity • NL: • Males: < 13° • Females: < 18° • In knee flexion, Q should be < 8°

  10. Palpation—p. 249 • Tibial Tuberosity • Patellar Tendon • Patella Borders • Synovial Plica • Crepitus with AROM • Patellar Mobility

  11. Clarke’s SignBox 7-5, p. 253 • Stabilize patella during quad set • (+) test=grinding + pain with QS • Many false (+)

  12. Synovial Plica—p. 253 • Histology • Med. Plica easier to palpate • Biomechanics

  13. Patellar Mobility—p. 254 • NML AROM: patella moves superiorly & laterally with flex-ext • Glide/Tilt (Box 7-6 & 7-7,p. 255-256) • NL Lateral glide=25%-50% • Hypomobile vs hypermobile • Indicates tightness of IT Band, pat. ret., capsule, VL

  14. Patellofemoral Pathologies

  15. Patellofemoral Pain Syndrome( PFPS) • Usually insidious onset • Pain greatest with ECC movements • AROM & RROM painful • Mild swelling possible • Usually accompanies maltracking patella &/or tight stabilizing structures • Orthotics may be helpful • McConnell Taping

  16. Meniscal vs Patellofemoral Findings—p. 257 • Meniscus Signs • Acute/twisting mechanism • Pain @joint line • Pain in full squat • No pain in sitting • Slow generalized edema • Locking possible • Patellofemoral Signs • Insidious/Overuse onset • Pain localized to patella tendon/patella • Stiffness, but no true locking • Pain with ECC motions • Pain with sitting • Localized inflammation

  17. Patellar Subluxation/ Dislocation—p. 259, Box 7-4, p. 260 • Acute or recurrent onset • Dislocates laterally • Predisposing factors: •  Q Angle • Lateral tracking • Hypermobile patella • Obvious deformity • (+) Apprehension test • May accompany MCL sprain

  18. Usually gradual onset with overuse activities Tenderness @ proximal or distal tendon Pain with AROM ext or PROM flexion Pain inc. with ECC loading Localized inflammation Check PMH and tracking Patellar Tendinitis—p. 259

  19. Osgood-Schlatter Disease—p. 265 (Table 7-9, p. 267) • Chronic inflammation of the tibial tuberosity growth plate • Osteochondritis • Symptoms similar to patellar tendinitis • Conservative treatment • Common in young athletes

More Related