61. Differential Diagnosis Of Conditions Causing Patellofemoral Pain Syndrome . Chondromalacia Patella The term chondromalacia patella has often been used interchangeablywith patellofemoral syndrome and anterior knee pain, however it is http://www.curtin.edu.au/curtin/dept/physio/podiatry/encyclopedia/kneepain/

Differential Diagnosis of Conditions Causing Patellofemoral Pain Syndrome AUTHOR: Anna Sokolowska This literature review was written as part of the undergraduate course at Curtin University of Western Australia. 1.0 Introduction. 2.0 Literature Review Presence of Cartilage Damage Variable Cartilage Damage ... 5.0 References 1.0 Introduction. The following paper aims at outlining the most common causes of anterior knee pain of which are commonly grouped into the category of Patellofemoral Pain Syndrome. Due to the enormity of the topic at hand acute injury related to trauma will be omitted. The purpose of the literature review is to briefly outline current concepts in the understanding of conditions, and the discussion will highlight details with respect to differential diagnosis. It is assumed that the reader has previous knowledge of knee biomechanics, as these will be briefly intimated in the formulation of etiological factors. A major limitation of this paper is the lack of inclusion of treatment strategy, largely due to the brevity of the paper in relation to size of the topic. Back to index.

62. Health Content Encyclopedia Article Anterior Knee Pain anterior knee pain. Alternate Names. knee pain runner's condition;Patellofemoral stress syndrome Definition. knee pain caused by http://www.centralbap.com/adamcontent/ency/article/001259.asp

63. Anterior Knee Pain anterior knee pain. Differential Diagnosis Patellofemoral overload (Chondromalacia).Patellofemoral Subluxation/ Instability. Plica syndrome. http://www.orthoteers.co.uk/Nrujp~ij33lm/Orthknee_ant_knee_pain.htm

Go Back to SYLLABUS Find in this Page: enter a search term and hit 'enter' (may take a few seconds) Search the Orthoteer Site: Anterior Knee Pain Differential Diagnosis: Patellofemoral overload (Chondromalacia) Patellofemoral Subluxation/ Instability Plica Syndrome 'Jumpers' knee (enthesitis of patella tendon origin) ... Osteochondritis Dissecans Patella Bursitis Bipartite Patella Patella cysts or tumours Osgood-Schlatters Disease First described by Paget in 1891 and later by Osgood and Schlatter in 1903 Traction injury to the apophysis where patella tendon inserts (some of patella tendon inserts on either side of the apophysis) Usually aged 11 - 15 years old and males are more common than females,usually no history of injury and may be bilateral Complains of pain after activity and the presence of a lump which is tender, and symptoms are aggravated by running, squatting, jumping, stairs etc X-Rays: May show fragmentation of the apophysis Spontaneous recovery is usual but takes time Where symptoms are persistent and troublesome excision of a separate ossicle may provide relief Sindig-Johansson-Larsen's disease Traction apophysitis of the distal pole of the patella Similar pathology to Osgood-Schlatters disease of the tibial tuberosity and usually resolves spontaneously Page Updated on: 29 January 2001 16:48

64. Health Library - Patellar Tracking Disorder This kind of pain, called anterior knee pain or patellofemoral pain syndrome,is sometimes caused by a common kneecap problem known as patellar tracking http://www.laurushealth.com/Library/HealthGuide/IllnessConditions/topic.asp?hwid

65. ICB Medical - Knee Pain of knee pain is chondromalacia or patello femoral syndrome generally caused and viceversa for lateral pain and supination, whereas anterior knee pain is often http://www.icbmedical.com/conditions/kneepain

ICB Medical Distributors Company Profile Products Fitting Instructions ... Wanted Knee Pain (Patello Femoral Syndrome or Chondromalacia Syndrome) Defined Can be a general term for general knee pain. If the knee cap is displaced and is not tracking correctly over the femur, inflammation and pain can occur to the underside of the patella. Knee pain can be a common problem among people active in sports which involve running and general flexing of the knee joint. One of the most common causes of knee pain is chondromalacia or patello femoral syndrome generally caused by an irritation of the undersurface of the kneecap (or patella). The irritation can lead to a roughening of the kneecap which normally should be smooth on the undersurface, a condition called chondromalacia. Symptoms The patient experiences acute pain at certain points of the biomechanical gait, generally resulting from pressure of the kneecap as it becomes irritated and roughened. The tracking of the patella is particularly important as it moves in a groove at the lower end of the femur (thigh bone). The patient may complain about pain either side or under the patella and often of a dull ache after exercise, including sporting activities, or upon rising from a prone or seated positions. Biomechanical Aetiology The amount of internal tibial "rotation" is directly proportional to the amount of excess pronation and so medial displacement of the patello femoral path laterally displaces the patella moving the patella from its correct tracking position and thereby encouraging wear and tear on the cartilage with resultant pain and inflammation.

66. SCSM - Information On Knee Injuries Patellofemoral pain syndrome is a clinical definition and not a per se correlateto the pain symptoms a consensus on treatment of anterior knee pain cannot be http://www.scsm.co.uk/clinical_gpknee.html

67. ESPN.com - TRAININGROOM - Patellofemoral Pain Syndrome This can result in anterior knee pain and that usually suggests an overuse syndromewhere the physical demands were beyond what the knee could withstand. http://espn.go.com/trainingroom/s/1999/0901/13988.html

Keyword Search ESPN.com Search The Web ESPN Network: ESPN.com NBA.com NHL.com ABCSports ... FANTASY Sport Sections NBA Scores NHL Scores ... ESPNdeportes More Sports Baseball-min. Fig. skating Football Other sports Broadcast ESPN Radio TV Listings Video Highlights Audio Highlights Community Sign-in/Home Chat Message Boards Arcade Games ESPN Inc. The Magazine ESPN Radio ESPNEWS ESPN Wireless ... ESPN Zone SPECIAL SECTIONS Fantasy Games Contests ESPN Classic SportsFigures ... Training Room Thursday, September 23 Patellofemoral pain syndrome It's an inescapable fact that knee injuries are a part of sports. One of the most complex joints in the body, the knee must withstand and absorb an incredible assortment of forces, both natural and unnatural, in order for an athlete to jump, run or cut. One of the structures of the knee, the patella (or kneecap) is particularly prone to pain and discomfort primarily because it sits at the juncture of ligaments, tendons, cartilage and bone. These afflictions, collectively referred to as patellofemoral pain syndrome, may have many causes. Dr. Giles Scuderi, a member of the Association of Professional Team Physicians (PTP) and an attending orthopedic surgeon at Beth Israel Medical Center, joins us to discuss this syndrome the causes, treatments and prognosis.

68. 10 / Injuries Of The Knee There is anterior knee pain with instability. If the patella dislocates the patientfalls to the ground (Figs 105 106). Iliotibial Band Friction syndrome. http://www.worldortho.com/sportsmed/chap10.html

Excerpts from COLOUR GUIDE SPORTS MEDICINE Eugene Sherry ISBN 0-443-05482-7 The paperback version with the complete text and all illustrations is available at all good medical book stores. 10 / Injuries of the Knee Eugene Sherry Mechanism of injury The knee is the most commonly injured part of the body in sport. Meniscal tears These usually occur when the flexed knee is externally rotated. The meniscus, usually the less mobile medial, is caught between the bone ends and torn (Fig. 97). Footballers and downhill snow skiers when changing direction are prone to this (Fig. 98). Clinical features Treatment This includes rest, ice, compression and elevation. Arthroscopic partial medial meniscectomy is indicated for a large tear which remains symptomatic. The meniscus is repaired when the tear is at the menisco-capular junction, especially in children (Fig. 99). Mechanism of injury Tears of the anterior cruciate ligament The cruciate ligaments stabilise the knee. The anterior cruciate (ACL) may rupture when a valgus/external rotating force is applied to the knee as when cutting in football or in the hyperflexed or hyperextended knee.

69. Patello-femoral Instability 8. plica syndrome. 9. osteochondritis disseccans. 10. discoid meniscus. 11. tornmeniscus. Historical Perspective. Initially anterior knee pain was attributed to http://www.worldortho.com/database/etext/patello.html

PATELLOFEMORAL INSTABILITY Dr. S. Hutabarat CONTENTS ANTERIOR KNEE PAIN CLINICAL EVALUATION RADIOLOGICAL EVALUATION TREATMENT Anterior knee pain 1. patellofemoral overload 2. overuse in athletes 3. jump knee (patellar tendonitis) 4. patellofemoral subluxation 5. bipartite patella 6. patellar cysts or tumours 7. prepatellar bursitis 8. plica syndrome 9. osteochondritis disseccans 10. discoid meniscus 11. torn meniscus Historical Perspective Initially anterior knee pain was attributed to chondromalacia patellae (1960's). Hughston: chondromalacia due to impingement of medial facet on lateral condyle during subluxation. Merchant: separated chondromalacia into normal and abnormal patellar alignment types, treatment involved lat release. Insall: excessive Q angle, patella alta. causes of dislocation and subluxation respectively, treatment by proximal realignmcnt. Ficat: tight lat retinaculum producing patellar tilt Maquet: lateral pressure synd Larson: lat retinac release Fulkerson: small nerve degen in tight lat retinac Schutzer: CT studies of malalignment Concepts: consider pain I instability dysplasia patella and patella femoral joint.

70. Untitled The diagnosis of the Patellofemoral pain syndrome can be challenging due to (2)pain usually relieved by (1) history of insidious onset of anterior knee pain. http://www.medal.org/docs_ch20/doc_ch20.29.html

with the Patella Table of Contents, Chap. 20 for the Patellofemoral Pain Syndrome Overview: The diagnosis of the Patellofemoral Pain Syndrome can be challenging due to various criteria used by different authors. Kumbhare gave criteria for the diagnosis based on consensus of 10 clinical experts familiar with the disorder. Criteria for diagnosis – all 3 of the following (1) appropriate history and clinical history (2) appropriate findings on physical examination (3) exclusion of other causes such as patella fracture or traumatic dislocations Additional findings: (1) age of the patient usually is from 12 – 35 years (adolescent and early adult) (2) pain usually relieved by rest or application of ice Appropriate history and clinical history involves all of the following: (1) history of insidious onset of anterior knee pain (2) retropatellar or peripatellar pain (3) pain exacerbated by jumping OR ascending stairs OR descending stairs (4) positive theater sign (worsening of pain with prolonged sitting relieved by straightening the knee) (5) history of crepitus Appropriate findings on clinical examination: both of the following (1) poorly developed vastus medialis obliquus (2) 2 or more of the following: • patella alta • femoral anteversion • external tibial torsion • hamstring muscle contracture • positive Clarke sign (pain elicited when the examiner presses the patella against the femur during quadriceps contraction with the knee fully extended) • tenderness of the medial or lateral patellar facet

71. 4G. Knee Pain catch up. anterior knee pain is generally thrown into a catchall categorydescribed as patello-femoral syndrome. A precise description http://isc.faqs.org/faqs/bicycles-faq/mountain-bikes/section-45.html

Single Page Top Document: Mountain Biking FAQ Previous Document: 4F. Weight Lifting Next Document: 4H. What to Carry 4G. Knee Pain J Wesley Prince [ wesprince@csra.net Top Document: Mountain Biking FAQ Previous Document: 4F. Weight Lifting Next Document: 4H. What to Carry Single Page By Archive-name By Author ... Help Send corrections/additions to the FAQ Maintainer: vccheng@gpu.srv.ualberta.ca Last Update March 29 2003 @ 00:39 AM

72. Welcome To The Shoulder Doctor Patellofemoral pain syndrome (PFPS) is a common knee disorder, which often pain areretropatellar pain, peripatellar pain, anterior knee pain, and runner's http://www.theshoulderdoc.com/index.cfm?fuseaction=ct.overview&content_id_int=68

73. Lahey Clinic | Orthopaedic Surgery: Chondromalacia Patella, Patellofemoral Syndr Chondromalacia Patella, Patellofemoral syndrome. «« Back. Clinical Features.anterior knee pain; Women Men; pain Associated With Going Downstairs; Crepitus. http://www.lahey.org/depts/ortho/Updates/patella.stm

Orthopaedic Updates Lahey Homepage Appointment Request Physician Finder Site Map / Search Chondromalacia Patella, Patellofemoral Syndrome Back What is chondromalacia Patella? The term chondromalacia patella refers specifically to a pathological condition resulting in structural changes in the cartilage surface of the kneecap. These changes may be as mild as softening and discoloration of the normally firm, white glistening surface. if the process continues, fissuring and fraying may occur with the more advanced stages resulting in full thickness cartilage loss with exposure of the underlying bone. The process may be localized to one small area or it may involve the entire surface of the patella. Because of these variations in the cartilage changes, the symptoms experienced by patients with chondromalacia may vary. The patella aids the quadriceps muscle in extending the knee by improving it's mechanical advantage. The articular surface of the patella is the thickest in the body (four to six millimeters). Walking on level ground exerts a patellofemoral force equivalent to one-half the body weight, climbing stairs between 3-8 times the body weight, and rising from a full squat can generate forces eight times the body weight. What causes chondromalacia Although chondromalacia may develop following an acute injury to the knee (direct blow, fracture, or dislocation of the patella), more commonly, it has an insidious onset not specifically related to any one traumatic event. Any anatomical variation which results in "mal tracking" of the patella in the femoral groove during knee motion, may expose the cartilage to larger loads than it can withstand resulting in abnormal wear. Predisposing factors include anatomical variations in patellofemoral groove, tight supporting structures, rotational malalignment of lower extremity (traumatic or developmental), or altered test alignments.

74. Infrapatellar Fat Pad Syndrome Infrapatellar Fat Pad syndrome. Although the fat pad has been implicated as a commoncause of anterior knee pain, there is insufficient evidence for this to be http://members.optushome.com.au/physio/infrapat.html

Infrapatellar Fat Pad Syndrome. Although the fat pad has been implicated as a common cause of anterior knee pain, there is insufficient evidence for this to be a definite fact. Additionally, as there are no clear clinical features, the condition is unable to be diagnosed and treated with any certainty. Anatomy A horizontal cleft is located in the posterior aspect of the infrapatellar fat pad. It is a common and normal MR imaging finding with a prevalence of 90%. The horizontal cleft is lined with synovium and its roof is formed by the ligamentum mucosum (infrapatellar plica). This cleft communicates with the knee joint. A distended cleft can form a prominent recess mimicking pathologic processes; conversely, disorders can arise in the cleft. Definition There is an ill-defined syndrome that involves pain and swelling of the infra-patella fat pad, sometimes referred to as Hoffa’s disease. At times the fat pad may be entrapped between the tibia and femoral joint surfaces resulting in a block to extension of the knee, verified at arthroscopy. The condition is considered to be related to impingement and inflammation of the infrapatellar fat pad. Aetiology It is considered that the infra-patellar fat pad can become symptomatic following a direct blow, or by impingement between the femoral condyles and the tibial plateaus in extension. It can be severely inflamed by hyperextension trauma or direct rubbing by the inferior pole of the patella. Thus, the fat pad may be the cause of acute pain. It has been proposed that fat pad pain is nearly always secondary to other knee joint pathology.

75. BI SYNDROME OF THE KNEE TREATED WITH ACUPUNCTURE WITH PATELLOFEMORAL PAIN SYNDRO to this problem, such as chondromalacia patellae, anterior knee pain, or knee arthralgia.The current terminology is Patellofemoral pain syndrome 5. Symptoms http://www.cmiacupuntura.com.br/Artigos/bi_syndrome.htm

BI SYNDROME OF THE KNEE TREATED WITH ACUPUNCTURE WITH PATELLOFEMORAL PAIN SYNDROME AS A CASE by Roar Jensen and Anders Baerheim Musculoskeletal problems are some of the most frequent seen health problems in acupuncture clinics. Pain seems to be the main complaint in addition to reduced function. According to Traditional Chinese Medicine (TCM) obstruction of qi and/or blood lead to pain. Soreness, swelling, and stiffness in muscles and joints develop if the obstruction is not cleared, and the normal function of the whole body can be affected. As a result, daily life, recreational activities and participation in sports suffer. Reduced ability to work may put a strain on private and community economy. Reduced function due to obstruction of qi or blood in the knees may affect all ages, both sexes, athletes and those with sedentary lifestyles. The patients experience pain in the knee on activity and/or at rest. It is claimed to affect as many as one in four of us, and as many as 15% of young men attending military service 1, 2. Adolescents participating in sports seem to be particularly vulnerable to knee problems3, and anterior knee pain is one of the main diagnoses at sports medicine centres4. In western medicine various terminology has been applied to this problem, such as chondromalacia patellae, anterior knee pain, or knee arthralgia. The current terminology is "Patellofemoral Pain Syndrome"5. Symptoms include chronic knee pain of insidious onset aggravated by walking uphill or downhill, squatting, kneeling, or prolonged sitting with flexed knees5. Excluded are those cases of anterior knee pain that occur secondary to trauma and/ or dislocation of the patella.

76. Orthopaedic Research Of Virginia - Anterior Knee Pain Rehabilitation Program Although the term “patellofemoral syndrome” has been commonly used in the past,“anterior knee pain” describes a more general condition involving the http://www.orv.com/patinfo/rehab_protocols/antkneepain.htm

Anterior Knee Pain Rehabilitation Program Phase I Clinical Goals: Decrease pain and control swelling Full ROM Increased flexibility Improved function Testing: Bilateral ROM Flexibility Gait Patella alignment/tracking Exercises: A.Control of pain and inflammation Application of ice bags or ice cups three to four times per day for ten to twenty minutes. Modalities such as high volt electrical stimulation and ultrasound/ice massage contrast may be of benefit in this phase of rehabilitation on a limited basis For patients with patellar tendonitis : deep transverse friction massage should be performed over the tender aspect of the patellar tendon for ten minutes one time per day.  The patient should glide the patella distally toward the foot.  The massage should be directed perpendicular to the patellar tendon using the thumb.  The massage will serve to reduce the unorganized alignment of collagen fibers and break up scar tissue during the healing process.  This will allow equal stress across the patellar tendon during muscle contraction and will help achieve normal length and strength of the patellar tendon. Non-steroidal anti-inflammatory medications as prescribed by their physician.

77. Home CME Articles ORTHOPEDICS ®. Volume 23 (6) * June 2000 * Feature Article (abstract). A New Conceptin the Treatment of anterior knee pain Patellar Hypertension syndrome. http://www.orthobluejournal.com/0600/6sch.asp

Volume 23 (6) * June 2000 * Feature Article (abstract) A New Concept in the Treatment of Anterior Knee Pain: Patellar Hypertension Syndrome ABSTRACT AUTHORS Reprint requests: U. Schneider, MD, Dept of Orthopedic Surgery, University of Heidelberg, Schlierbacher Landstrabe 200a, 69118 Heidelberg, Germany. Orthopedics Homepage CME Articles Current Issue Back Issues ... Subscribe to the Journal e-mail: ortho@slackinc.com Revised 19 February 2003.

78. UIUC Kinesiology - KINES 121 Patellofemoral pain syndrome. Commonly known as anterior knee pain.Affects femalesmore than males.Runners and Jumping activities.25% of what we see in Sports http://www.kines.uiuc.edu/courses/kines121/knee.html

KNEE INJURIES Normal Anatomy Overuse Knee Injuries ITB Friction Syndrome Inflammation of the distal fibers of the ITB tendon, and the bursa over the lateral epicondyle. Caused by single long hard run, increase in training distances. Pain with walking, running, palpation. Rehab:Ice, decrease in training, stretching, US. Patellofemoral Pain Syndrome Commonly known as anterior knee pain.Affects females more than males.Runners and Jumping activities.25% of what we see in Sports Med C Not exactly sure why it occurs.Weak VMO, Biomechanics of lower limb. Pain is under the kneecap and to the medial side. Rehab:Correction of biomechanical factors, VMO strengthening, McConnell taping. Patellar Tendinitis Its called the Jumpers knee. Inflammation of the patellar tendon due to tendon repetitive microstrains from eccentric contractions of the tendon. Basketball is a common sport and field events. Some biomechanical factors may predispose to injury like hamstrings inflexibility. Rehab:Ice, Nsaids, US and flexibility and strengthening exercises. Pes Anserinus Bursitis There is a bursa that lies over the Pes Anserinus- common insertion of the semitendinosus, gracilis and sartorius.

79. Knee Syndromes And Arthroscopic Knee Procedures 3 Lateral pain syndrome. anterior knee pain. Many people, of all ages and sportingactivity, have pain generally located to the front (anterior) of the knee. http://www.kneeclinic.com.au/papers/ArthProcedures.htm

Knee Clinic Home About Dr. Mervyn Cross Information for patients Papers online ... Presentations online Other info R.L.Morgan-Jones Knee Fellow M.J.Cross O.A.M. Orthopaedic Knee Surgeon There are many knee operations that can be performed using an arthroscope. Most operations can be done as a day-case procedure although many patients require a period of muscle strengthening afterwards to obtain the best outcome. Below is an outline of the commonest "knee syndromes" and the arthroscopic procedures used to treat them. 1: Locked Knee A torn meniscus can displace into the knee joint causing a mechanical block to extension and resulting in pain and muscle spasm. The classic type of meniscal tear producing a locked knee is the "Bucket Handle" tear. The torn meniscus remains attached front and back allowing the central torn portion to flip into the knee joint like the handle of a bucket. As the pain and spasm reduce the displaced meniscus can drop back allowing the knee to move freely again. This mechanical "locking" of the knee can be an intermittent feature with symptomless periods of in-between episodes. 2: Medial Pain Syndrome The gradual onset of pain aggravated by twisting, squatting and catching your toe; as well as pain at night when you sleep on the side with legs together. This is typical of a cleavage tear of the medial (inner) meniscus which can intermittently be "pinched" by the knee joint as it flexes or twists suddenly. In-between episodes the torn portion of meniscus can fold away under the untorn meniscus and the knee become pain free.

80. MANAGEMENT AND REHAB OF KNEE LESIONS Table of Contents. knee ALIGNMENT. anterior CRUCIATE LIGAMENT INJURIES. anteriorCRUCIATE LIGAMENT INJURIES. MENISCAL INJURIES. PATELLOFEMORAL pain syndrome. http://www.floyd.edu/subwebs/pta/Knee-Ortho Managehtml/PTAP 1104-KNEE-ORTHO MANA

MANAGEMENT AND REHABILITATION OF KNEE LESIONS Click here to start Table of Contents KNEE ALIGNMENT COLLATERAL LIGAMENT INJURIES MANAGEMENT MANAGEMENT ... RETURN TO PTAP 1104 HOME PAGE

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