A 25-year-old female presents with a gradual onset of bilateral knee pain, which she has had for the last two months. The patient reports that the pain is increased with running, ascending and descending steps, squatting, and sitting for greater than 20 minutes. She rated the most painful activities as 6/10 at worst and reported pain and 0/10 at rest.
Even based on this brief history, what is the probable cause of this patient's knee disorder?
This subjective history is highly suggestive of a patellofemoral dysfunction.
- Postural assessment revealed bilateral subtalar pronation with navicular drop greater than 3 mm and bilateral calcaneus valgus in standing.
- Range of motion assessment revealed normal knee range of motion, limited hip internal rotation, with a side to side difference of 20 degrees, excessive ankle dorsiflexion of 20 degrees bilaterally, and limited great to extension less than 50 degrees bilaterally.
- Muscle length assessment revealed decreased flexibility of the hamstrings, quadriceps, iliotibial band complex, and hip flexors.
- Manual muscle testing demonstrated weakness of the gluteus medius and maximus.
- Provocative patella compression testing was negative.
- Limited inferior glide of the patella and limited caudal hip glide bilaterally.
- Step-down test was provocative for pain bilaterally, and was not relieved with taping.
Based on the findings from the physical examination, what would be your provisional diagnosis?
What is the femoral trochlear sulcus angle, and how does it relate to patellofemoral instability?
How do the points of articular contact of the patella change during the arc of knee motion?
What are the static stabilizers of the patellofemoral joint?
What are the dynamic stabilizers of the patellofemoral joint?
What is the role of the vastus medialis obliquus (VMO) during knee extension?
Which age and gender group show a higher predisposition for patellofemoral disorders?
What is femoral neck anteversion and how does it affect patella tracking at the knee?
How do the angles of attachment of the quadriceps muscles predispose for lateral patella tracking?
What are the variations of patellar shape and facet configuration, and what is their clinical significance?
What is the effect of lower limb musculature tightness upon patellofemoral tracking?
Having made the provisional diagnosis, what will be your intervention?
In order of priority, what will be the goals of your intervention?
The differential between the proximal (quadriceps tendon) and distal aspect (patellar ligament) of the ...