Patellofemoral Syndrome Clinical Presentation

  • Author: Patrick J Potter, MD, FRCP(C); Chief Editor: Consuelo T Lorenzo, MD   more...
 
Updated: Feb 16, 2012
 

History

  • Knee pain is the most common presentation of patellofemoral syndrome.
    • The pain characteristically is located behind the kneecap (ie, retropatellar) and most often manifests during activities that require knee flexion and forceful contraction of the quadriceps (eg, during squats, ascending/descending stairs).
    • Pain may worsen in intensity, duration, and rapidity of onset if the aggravating activity is performed repeatedly.
    • Pain may be exacerbated by sitting with the knee flexed for a protracted period of time, such as while watching a movie, hence leading to the terms "theatre sign" and "movie-goer's knee." Patients with this condition often may prefer to sit at an aisle seat, where they may more frequently keep the knee extended.
  • Symptoms often occur during the activity, such as playing volleyball for 30 minutes, or may occur later after the activity has been completed.
  • Sometimes symptoms manifest as late as the next day.
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Physical

Physical examination of a patient with patellofemoral syndrome should include examination of the musculoskeletal system, including the following[2] :

  • The upper and lower body should be examined to exclude generalized diseases that make up the differential diagnoses (eg, osteoarthritis).
  • The usual physical findings are localized around the knee.
  • Tenderness often is present along the facets of the patella. The facets are most accessible to palpation by manipulation of the patella while the knee is fully extended and the quadriceps muscle is relaxed. Manual positioning of the patella medially, laterally, superiorly, and inferiorly allows for palpation of the respective facets.
  • An apprehension sign may be elicited by manually fixing the position of the patella against the femur and having the patient contract the ipsilateral quadriceps.
  • Crepitus may be present, but if present in isolation, crepitus does not allow for definitive diagnosis.
  • Determine the Q-angle by measuring the angle between the tibia and femur. Use the attachment of the patella to the patellar tendon as the intersection point.
  • Examination of gait may demonstrate excessive foot pronation, excessive knee valgus, or an antalgic gait pattern.
  • Repetitive squatting may reproduce knee pain.
  • Use the physical examination and historical details to help exclude other diagnoses.
  • Examination of the contralateral limb is equally important, as the syndrome often is bilateral. However, one side usually manifests more symptoms.
  • Palpation of the tibial tuberosity may detect tenderness suggesting that other impairments also are present.
  • Determining the bulk of the vastus medialis is possible, because it is situated superficially and has little overlying tissue. Bulk may be observed by direct visualization during contraction. The vastus medialis is believed to be the most active muscle in the last 15° of resisted knee extension, making this the best arc of movement for assessing its strength.
  • Genu recurvatum and hamstring weakness may contribute to the occurrence of PFS, and therefore, identifying such impairments may aid in the choice of management.
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Causes

The potential causes of patellofemoral syndrome remain controversial and are therefore more appropriately referred to as associated factors.[1] Overuse, overloading, and misuse of the patellofemoral joint seem to be the cornerstone factors on which most authors agree.

In a 2011 study of high school running athletes, the results suggest that stronger preinjury hip abductors and weaker preinjury hip external rotators are linked to PFS development. Also, patients exhibiting PFS seem to lose hip abduction and external rotation strength in comparison with their preinjury strength. A higher hip external-to-internal rotation strength ratio was found to possibly protect against PFS development.[3]

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Contributor Information and Disclosures
Author

Patrick J Potter, MD, FRCP(C)  Associate Professor, Department of Physical Medicine and Rehabilitation, University of Western Ontario School of Medicine; Consulting Staff, Department of Physical Medicine and Rehabilitation, St Joseph's Health Care Centre

Patrick J Potter, MD, FRCP(C) is a member of the following medical societies: American Paraplegia Society, Canadian Association of Physical Medicine and Rehabilitation, Canadian Medical Association, College of Physicians and Surgeons of Ontario, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Coauthor(s)

Keith Aj Sequeira  MD, FRCPC, Associate Professor, Director of Education, Department of Physical Medicine and Rehabilitation, Parkwood Hospistal, University of Western Ontario

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM  President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, International Association for the Study of Pain, and Texas Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Patrick M Foye, MD  Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society

Disclosure: Nothing to disclose.

Kelly L Allen, MD  Medical Director, Medevals

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD  Physiatrist, Department of Physical Medicine and Rehabilitation, Alegent Health Immanuel Rehabilitation Center

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

References

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