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Chapter 8: Patellofemoral Pathologies

Clinical Examination of the Patellofemoral Joint

Examination Map HISTORY

Past Medical History

History of the Present Condition

FUNCTIONAL ASSESSMENT

Gait Analysis

INSPECTION

Patella Alignment

Normal

Patella alta

Patella baja

Squinting

"Frog eyed"

Patellar Orientation

Medial/lateral glide

Spin

Anterior/posterior tilt

Medial/lateral tilt

Lower Extremity Posture

Genu varum

Genu valgum

Genu recurvatum

Q-Angle

Patellar Tendon

Tubercle Sulcus Angle

Leg-Length Difference

Foot Posture

Palpation

Palpation of the Anterior Structures

Tibial tuberosity

Patellar tendon

Patellar bursae

  • Subcutaneous infrapatellar

  • Deep infrapatellar

Fat pads

Patellar articulating surface

Femoral trochlea

Suprapatellar bursa

Medial patellofemoral ligament

Medial patellar retinaculum

Synovial plica

Lateral patellar retinaculum

Pes anserine insertion

Iliotibial band

JOINT AND MUSCLE FUNCTION ASSESSMENT

Goniometry

Knee flexion

Knee extension

Active Range of Motion

Knee flexion

Knee extension

Manual Muscle Tests

Knee extension

Knee flexion

Isolating the sartorius

Passive Range of Motion

Flexion

Extension

JOINT STABILITY TESTS

Stress Testing

Testing of the major knee

ligaments may be indicated.

Joint Play Assessment

Medial patellar glide

Lateral patellar glide

Patellar tilt

Patellar spin

Selective Tissue Tests

Ober test

Navicular drop test

NEUROLOGICAL EXAMINATION

Lower Quarter Screen

Common Peroneal Nerve Assessment

VASCULAR EXAMINATION

Distal Capillary Refill

Distal Pulse

Posterior tibial artery

Dorsal pedal artery

REGION-SPECIFIC PATHOLOGIES AND SELECTIVE TISSUE TESTS

Patellofemoral Pain Syndrome

Patellofemoral Instability

Apprehension test

Patellar Dislocation

Patellofemoral Tendinopathy

Apophysitis

Osgood-Schlatter disease

Sinding-Larsen-Johansson disease

Patellofemoral bursitis

Synovial plica

Traumatic Conditions

Patellar fracture

Patellar Tendon Rupture

History

Table 8-1Differential Diagnosis Between Meniscal and Patellar Pathology
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Table 8-1 Differential Diagnosis Between Meniscal and Patellar Pathology
History Meniscus Patella
Onset Usually acute twisting injury; may occur secondary to degenerative changes Occasionally direct anterior knee blow but usually insidious related to overuse and training errors
Symptom Site Localized medial or lateral joint line Diffuse, most commonly anterior
Locking Frank transient locking episodes with the knee unable to fully terminally extend Catching without locking, stiffness after immobility
Weight Bearing Pain sharp and simultaneous with loaded weight bearing Pain possibly coming on during weight bearing but often continuing into the evening and night
Cutting Sports Pain with loaded twisting maneuvers Some pain possible but not sharp or clearly related to cutting
Squatting Pain at full squat; inability to "duck walk" Pain when extensors used to descend or rise from a squat
Kneeling Not painful because meniscus is not weight loaded Pain from patellar compression
Jumping Loading without torque or twist tolerated Extensors heavily stressed, causing pain on descent impact
Stairs or Hills Pain often going upstairs with loaded knee flexion More patellar loading and pain going downstairs because gravity-assisted impact increases patellofemoral stress
Sitting No pain Stiffness and pain from lack of the distraction-compression effect on abnormal articular cartilage

Inspection

FIGURE 8-1

Normal patellar alignment with the knee extended.

image
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image Inspection Findings 8-1: Patellar Alignment

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