Quadriceps atrophy: to what extent does it exist in patellofemoral pain syndrome?
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BACKGROUND: Quadriceps atrophy is a commonly cited accompaniment to patellofemoral pain syndrome (PFPS), yet there is little valid, objective evidence for its existence. OBJECTIVE: To investigate atrophy and weakness of the quadriceps femoris muscle group in patients with PFPS using measures of cross-sectional area and peak extension torque. METHODS: A total of 57 patients with insidious onset of PFPS and 10 healthy control subjects had ultrasound scanning of the quadriceps femoris. The scans were analysed using computerised planimetry to estimate the cross-sectional area of the quadriceps femoris. Lower limb peak torque was also measured using a Biodex dynamometer. RESULTS: The mean of % differences revealed a 3.38% (95% confidence interval (CI) 1.3 to 5.45) difference in cross-sectional area (CSA) between the affected and unaffected limb in PFPS patients and a 1.31% (95% CI 0.06 to 2.55) difference in the dominant and non-dominant limb of the control group; the between-groups difference was not significant (p = 0.409). There was a 18.4% (95% CI 13 to 23.8) difference between the affected and unaffected limb in peak torque in PFPS patients and a 7.6% (95% CI 3.2 to 12) difference between the dominant and non-dominant limb in the control group; the between-groups difference was significant (p = 0.002). CONCLUSIONS: The mean of % differences of 3.38% quadriceps atrophy between limbs was considerably less than the only other study using ultrasound scanning on the quadriceps in PFPS and was not significant between the groups. There were greater and more significant between-group differences in lower limb peak torque indicating that muscle strength may not be related to muscle size. These results help to re-appraise of the amount of quadriceps atrophy in PFPS. (+info)
Relation between running injury and static lower limb alignment in recreational runners.
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OBJECTIVES: To determine if measurements of static lower limb alignment are related to lower limb injury in recreational runners. METHODS: Static lower limb alignment was prospectively measured in 87 recreational runners. They were observed for the following six months for any running related musculoskeletal injuries of the lower limb. Injuries were defined according to six types: R1, R2, and R3 injuries caused a reduction in running mileage for one day, two to seven days, or more than seven days respectively; S1, S2, and S3 injuries caused stoppage of running for one day, two to seven days, or more than seven days respectively. RESULTS: At least one lower limb injury was suffered by 79% of the runners during the observation period. When the data for all runners were pooled, 95% confidence intervals calculated for the differences in the measurements of lower limb alignment between the injured and non-injured runners suggested that there were no differences. However, when only runners diagnosed with patellofemoral pain syndrome (n = 6) were compared with non-injured runners, differences were found in right ankle dorsiflexion (0.3 to 6.1), right knee genu varum (-0.9 to -0.3), and left forefoot varus (-0.5 to -0.4). CONCLUSIONS: In recreational runners, there is no evidence that static biomechanical alignment measurements of the lower limbs are related to lower limb injury except patellofemoral pain syndrome. However, the effect of static lower limb alignment may be injury specific. (+info)
Diffusely increased bone scintigraphic uptake in patellofemoral pain syndrome.
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OBJECTIVES: Painful disorders of the patellofemoral joint are one of the most frequent complaints in orthopaedic and sports medicine. The aims of this study were to determine whether bone scintigrams of patients suffering from patellofemoral pain syndrome (PFPS) show diffuse uptake and in what bony compartment of the knee uptake, if any, was localised. METHODS: Fifty eight patients with chronic PFPS were examined. All patients underwent a detailed clinical history and a thorough physical examination of the knee. Anterior and lateral static images of both knees were made using a gamma camera 3 h after injection of 550 MBq of (99m)Tc-HMDP. Two experienced radiologists visually evaluated the scans blindly and separately. As 51 patients had bilateral pain, 109 painful knees are included in the results. RESULTS: Diffuse uptake on bone scintigrams was found in 48 knees in 30 of the patients. In 33 knees the uptake was localised to only one bone compartment, in 10 knees diffuse uptake was found in two of the bones forming the knee joint, and in six knees all three bone compartments (the distal femur, the patella, and the proximal tibia) exhibited diffuse uptake. CONCLUSIONS: Scintigrams of approximately half of the patients with PFPS will show diffuse uptake in one or more of the bony compartments of the knee joint and radioactive tracer accumulation will occur as often in the proximal tibia as in the patella. (+info)
Patellofemoral pain and asymmetrical hip rotation.
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BACKGROUND AND PURPOSE: Patellofemoral joint problems are the most common overuse injury of the lower extremity, and altered femoral or hip rotation may play a role in patellofemoral pain. The purpose of this case report is to describe the evaluation of and intervention for a patient with asymmetrical hip rotation and patellofemoral pain. CASE DESCRIPTION: The patient was a 15-year-old girl with an 8-month history of anterior right knee pain, without known trauma or injury. Prior to intervention, her score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was 24%. Right hip medial (internal) rotation was less than left hip medial rotation, and manual muscle testing showed weakness of the right hip internal rotator and abductor muscles. The intervention was aimed at increasing right hip medial rotation, improving right hip muscle strength (eg, the muscle force exerted by a muscle or a group of muscles to overcome a resistance), and eliminating anterior right knee pain. OUTCOMES: After 6 visits (14 days), passive left and right hip medial rotations were symmetrical, and her right hip internal rotator and abductor muscle grades were Good plus. Her WOMAC score was 0%. DISCUSSION: The patient had right patellofemoral pain and an uncommon pattern of asymmetrical hip rotation, with diminished hip medial rotation and excessive hip lateral (external) rotation on the right side. The patient's outcomes suggest that femoral or hip joint asymmetry may be related to patellofemoral joint pain. (+info)
How evidence based is the management of two common sports injuries in a sports injury clinic?
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OBJECTIVES: To examine the diagnosis and management of adults attending a sports injury clinic, to establish to what extent the management of the two most common injuries treated at this clinic is evidence based, and to explore factors that affect management. METHODS: A retrospective examination of 100 random case notes extracted age, sex, sport, type and site of injury, treatment, and outcome. Systematic literature reviews examined the extent and quality of scientific evidence for the management of the two most commonly presenting injuries. A clinical attachment period and practitioner interviews allowed recognition of factors impinging on management decisions. RESULTS: Patellofemoral pain syndrome (PFPS; 10% of all injuries) and Achilles tendinopathy (6% of all injuries) were the most commonly presenting injuries. The mean (SD) number of treatments used for PFPS was 2.8 (0.9). The mean number of treatments used for Achilles tendinopathy was 3.7 (1.0). Clinicians reported that personal experience formed the basis of management plans in 44% of PFPS cases and 59% of Achilles tendinopathy cases, and that primary research evidence only accounted for 24% of management plans in PFPS and 14% in Achilles tendinopathy. Practitioners were unaware of literature supporting over 50% of the treatment modalities they used. However, clinicians were often using evidence based treatments, unaware of the supporting research data. CONCLUSIONS: This study highlights a lack of evidence base, a lack of knowledge of the research evidence, and a lack of management based on the current evidence that is available for these conditions. Practitioners practised evidence based medicine in under 50% of cases. (+info)
Patellar taping does not change the amplitude of electromyographic activity of the vasti in a stair stepping task.
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OBJECTIVES: To investigate the effect of patellar taping on the amplitude of electromyographic activity (EMG) of vasti activation in subjects with and without patellofemoral pain (PFP). METHODS: Ten participants with PFP and 12 asymptomatic controls were recruited to the study. The study was designed as a randomised crossover trial. Participants completed a stair stepping task. Three experimental conditions were assessed: no tape, therapeutic medially directed tape, and placebo vertically directed tape. The main outcome measure was the EMG amplitude of the vastus medialis obliquus and vastus lateralis during the concentric phase of stair stepping. RESULTS: The application of medially directed therapeutic tape significantly decreased pain in subjects with PFP. However, application of tape over the patella (therapeutic or placebo) did not alter the amplitude of vasti EMG when either the PFP or control participants completed the concentric stair stepping task. CONCLUSION: The results of this study indicate that the positive clinical effects of medially directed therapeutic tape are not due to changes in EMG amplitude of the vasti muscle. Thus other effects such as changes in timing of contraction of the vasti are more likely candidates for the mechanism of efficacy. (+info)
Reliability of measures of impairments associated with patellofemoral pain syndrome.
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BACKGROUND: The reliability and measurement error of several impairment measures used during the clinical examination of patients with patellofemoral pain syndrome (PFPS) has not been established. The purpose was to determine the inter-tester reliability and measurement error of measures of impairments associated with PFPS in patients with PFPS. METHODS: A single group repeated measures design was used. Two pairs of physical therapists participated in data collection. Examiners were blinded to each others' measurements. RESULTS: Thirty patients (age 29 +/- 8; 17 female) with PFPS participated in this study. Inter-tester reliability coefficients were substantial for measures of hamstrings, quadriceps, plantarflexors, and ITB/TFL complex length, hip abductors strength, and foot pronation (ICCs from .85 to .97); moderate for measures of Q-angle, tibial torsion, hip external rotation strength, lateral retinacular tightness, and quality of movement during a step down task (ICCs from .67 to .79); and poor for femoral anteversion (ICC of .45). Standard error of measurement (SEM) for measures of muscle length ranged from 1.6 degrees to 4.3 degrees. SEM for Q-angle, tibial torsion, and femoral anteversion were 2.4 degrees, 2.9 degrees, and 4.5 degrees respectively. SEM for foot pronation was 1 mm. SEM for measures of muscle strength was 1.8 Kg for abduction and 2.4 Kg for external rotation. CONCLUSION: Several of the impairments associated with PFPS had sufficient reliability and low measurement error. Further investigation is needed to test if these impairment measurements are related to physical function and whether or not they are useful for decision-making. (+info)
The knee skyline radiograph: its usefulness in the diagnosis of patello-femoral osteoarthritis.
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The aim of this study was to determine the usefulness of the skyline radiograph in the diagnosis of patellofemoral osteoarthritis. Additionally, we wanted to assess the usefulness of patello-femoral crepitus as a clinical sign of this condition. Seventy-seven patients scheduled to undergo knee surgery had standard antero-posterior, lateral and skyline X-rays of their affected knee. The presence of clinical patello-femoral crepitus was also documented preoperatively. At the operation, their patellofemoral joints were graded into two groups according to the presence or absence of osteoarthritis. The lateral and skyline view X-rays as well as patello-femoral crepitus were compared individually against the operative findings. The skyline view had a sensitivity of 79% and a specificity of 80%. The lateral view had a sensitivity of 82% and specificity of 65%. Patello-femoral crepitus as a sign had a sensitivity of 89% and a specificity of 82%. There was no statistically significant difference between the two radiological views in terms of sensitivity and specificity in the diagnosis of patellofemoral osteoarthritis. Hence, we cannot recommend the skyline view as a routine radiological investigation in all cases of suspected patellofemoral osteoarthritis. (+info)