eMedicine Specialties > Sports Medicine > Knee

Patellar Injury and Dislocation: Multimedia

Author: Gerard A Malanga, MD, Founder and Director, New Jersey Sports Medicine Institute; Director of Pain Management, Overlook Hospital; Director of Sports Medicine, Sports Medicine Fellowship Director, Mountainside Hospital; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Medical Director, Consultant, Horizon Healthcare Worker's Compensation Services, Blue Cross and Blue Shield Worker's Compensation
Coauthor(s): Brian F White, DO, Staff Physician, Department of Physical Medicine and Rehabilitation, Kessler Institute for Rehabilitation, University of Medicine and Dentistry of New Jersey; Wah Sang Lee, DO, MS, Staff Physician, Department of Physical Medicine and Rehabilitation, New Jersey Medical School/Kessler Institute of Rehabilitation; Thomas Agesen, MD, Assistant Clinical Professor, Department of Physical Medicine and Rehabilitation, UMDNJ, New Jersey Medical School; Consulting Staff, Mountainside Hospital, Summit Overlook Hospital
Contributor Information and Disclosures

Updated: Sep 8, 2008

Multimedia

Apprehension sign. The knee is placed at 30°...
(Enlarge Image)
Media file 1: Apprehension sign. The knee is placed at 30° flexion, and lateral pressure is applied. Medial instability results in apprehension by the patient.
[ CLOSE WINDOW ]
Apprehension sign. The knee is placed at 30°...

Apprehension sign. The knee is placed at 30° flexion, and lateral pressure is applied. Medial instability results in apprehension by the patient.

Anatomic morphology of patellar insertion into th...
(Enlarge Image)
Media file 2: Anatomic morphology of patellar insertion into the intercondylar notch.
[ CLOSE WINDOW ]
Anatomic morphology of patellar insertion into th...

Anatomic morphology of patellar insertion into the intercondylar notch.

Muscles influencing patellar biomechanics.
(Enlarge Image)
Media file 3: Muscles influencing patellar biomechanics.
[ CLOSE WINDOW ]
Muscles influencing patellar biomechanics.

Muscles influencing patellar biomechanics.

The <em>Q</em> angle can be measured while the pa...
(Enlarge Image)
Media file 4: The Q angle can be measured while the patient is standing or while the knee is at 20° of flexion (ie, at neutral), with maximum internal or external rotation of the tibia.
[ CLOSE WINDOW ]
The <em>Q</em> angle can be measured while the pa...

The Q angle can be measured while the patient is standing or while the knee is at 20° of flexion (ie, at neutral), with maximum internal or external rotation of the tibia.

Ligament constraints of the patella.
(Enlarge Image)
Media file 5: Ligament constraints of the patella.
[ CLOSE WINDOW ]
Ligament constraints of the patella.

Ligament constraints of the patella.

More on Patellar Injury and Dislocation

Overview: Patellar Injury and Dislocation
Differential Diagnoses & Workup: Patellar Injury and Dislocation
Treatment & Medication: Patellar Injury and Dislocation
Follow-up: Patellar Injury and Dislocation
Multimedia: Patellar Injury and Dislocation
References
[ CLOSE WINDOW ]

References

  1. Räty HP, Kujala UM, Videman T, et al. Lifetime musculoskeletal symptoms and injuries among former elite male athletes. Int J Sports Med. Nov 1997;18(8):625-32. [Medline].

  2. Thijs Y, De Clercq D, Roosen P, Witvrouw E. Gait-related intrinsic risk factors for patellofemoral pain in novice recreational runners. Br J Sports Med. Jun 2008;42(6):466-71. [Medline].

  3. Hahn T, Foldspang A. Prevalent knee pain and sport. Scand J Soc Med. Mar 1998;26(1):44-52. [Medline].

  4. Aoyagi K, Ross PD, et al. Prevalence of joint pain is higher among women in rural Japan than urban Japanese-American women in Hawaii. Ann Rheum Dis. May 1999;58(5):315-9. [Medline]. [Full Text].

  5. Zhang Y, Xu L, Nevitt MC, et al. Comparison of the prevalence of knee osteoarthritis between the elderly Chinese population in Beijing and whites in the United States: The Beijing Osteoarthritis Study. Arthritis Rheum. Sep 2001;44(9):2065-71. [Medline]. [Full Text].

  6. Nietosvaara Y, Aalto K, Kallio PE. Acute patellar dislocation in children: incidence and associated osteochondral fractures. J Pediatr Orthop. Jul-Aug 1994;14(4):513-5. [Medline].

  7. Andrikoula S, Tokis A, Vasiliadis HS, Georgoulis A. The extensor mechanism of the knee joint: an anatomical study. Knee Surg Sports Traumatol Arthrosc. Mar 2006;14(3):214-20. [Medline].

  8. Escala JS, Mellado JM, Olona M, et al. Objective patellar instability: MR-based quantitative assessment of potentially associated anatomical features. Knee Surg Sports Traumatol Arthrosc. Mar 2006;14(3):264-72. [Medline].

  9. Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc. 1994;2(1):19-26. [Medline].

  10. Post WR, Teitge R, Amis A. Patellofemoral malalignment: looking beyond the viewbox. Clin Sports Med. Jul 2002;21(3):521-46, x. [Medline].

  11. Bongers EM, van Kampen A, van Bokhoven H, Knoers NV. Human syndromes with congenital patellar anomalies and the underlying gene defects. Clin Genet. Oct 2005;68(4):302-19. [Medline].

  12. Amin S, Goggins J, Niu J, et al. Occupation-related squatting, kneeling, and heavy lifting and the knee joint: a magnetic resonance imaging-based study in men. J Rheumatol. Aug 2008;35(8):1645-9. [Medline].

  13. Grelsamer RP, Dubey A, Weinstein CH. Men and women have similar Q angles: a clinical and trigonometric evaluation. J Bone Joint Surg Br. Nov 2005;87(11):1498-501. [Medline].

  14. Verma A, Su A, Golin AM, O'Marrah B, Amorosa JK. A screening method for knee trauma. Acad Radiol. May 2001;8(5):392-7. [Medline].

  15. Stanciu C, Labelle HB, Morin B, Fassier F, Marton D. The value of computed tomography for the diagnosis of recurrent patellar subluxation in adolescents. Can J Surg. Aug 1994;37(4):319-23. [Medline].

  16. Shea KP, Fulkerson JP. Preoperative computed tomography scanning and arthroscopy in predicting outcome after lateral retinacular release. Arthroscopy. 1992;8(3):327-34. [Medline].

  17. McNally EG, Ostlere SJ, Pal C, et al. Assessment of patellar maltracking using combined static and dynamic MRI. Eur Radiol. 2000;10(7):1051-5. [Medline].

  18. Brossmann J, Muhle C, Büll CC, et al. Evaluation of patellar tracking in patients with suspected patellar malalignment: cine MR imaging vs arthroscopy. AJR Am J Roentgenol. Feb 1994;162(2):361-7. [Medline]. [Full Text].

  19. Mäenpää H, Lehto MU. Patellar dislocation. The long-term results of nonoperative management in 100 patients. Am J Sports Med. Mar-Apr 1997;25(2):213-7. [Medline].

  20. Neptune RR, Wright IC, van den Bogert AJ. The influence of orthotic devices and vastus medialis strength and timing on patellofemoral loads during running. Clin Biomech (Bristol, Avon). Oct 2000;15(8):611-8. [Medline].

  21. Shellock FG, Mink JH, Deutsch AL, Molnar T. Effect of a newly designed patellar realignment brace on patellofemoral relationships. Med Sci Sports Exerc. Apr 1995;27(4):469-72. [Medline].

  22. Gilleard W, McConnell J, Parsons D. The effect of patellar taping on the onset of vastus medialis obliquus and vastus lateralis muscle activity in persons with patellofemoral pain. Phys Ther. Jan 1998;78(1):25-32. [Medline]. [Full Text].

  23. Mohr KJ, Kvitne RS, Pink MM, Fideler B, Perry J. Electromyography of the quadriceps in patellofemoral pain with patellar subluxation. Clin Orthop Relat Res. Oct 2003;415:261-71. [Medline].

  24. Earl JE, Schmitz RJ, Arnold BL. Activation of the VMO and VL during dynamic mini-squat exercises with and without isometric hip adduction. J Electromyogr Kinesiol. Dec 2001;11(6):381-6. [Medline].

  25. Buchner M, Baudendistel B, Sabo D, Schmitt H. Acute traumatic primary patellar dislocation: long-term results comparing conservative and surgical treatment. Clin J Sport Med. Mar 2005;15(2):62-6. [Medline].

  26. Arendt EA, Fithian DC, Cohen E. Current concepts of lateral patella dislocation. Clin Sports Med. Jul 2002;21(3):499-519. [Medline].

  27. Sillanpää P, Mattila VM, Visuri T, Mäenpää H, Pihlajamäki H. Ligament reconstruction versus distal realignment for patellar dislocation. Clin Orthop Relat Res. Jun 2008;466(6):1475-84. [Medline].

  28. Panagopoulos A, van Niekerk L, Triantafillopoulos IK. MPFL reconstruction for recurrent patella dislocation: a new surgical technique and review of the literature. Int J Sports Med. May 2008;29(5):359-65. [Medline].

  29. Krause F, Kolling C, Brantschen R, Sieber HP. [Medium-term results after m. vastus medialis obliquus-plasty for lateral patellar dislocation] [German]. Orthopade. Jan 2006;35(1):94-101. [Medline].

  30. Christoforakis J, Bull AM, Strachan RK, et al. Effects of lateral retinacular release on the lateral stability of the patella. Knee Surg Sports Traumatol Arthrosc. Mar 2006;14(3):273-7. [Medline].

  31. Haspl M, cicak N, Klobucar H, Pecina M. Fully arthroscopic stabilization of the patella. Arthroscopy. Jan 2002;18(1):E2. [Medline].

  32. Nam EK, Karzel RP. Mini-open medial reefing and arthroscopic lateral release for the treatment of recurrent patellar dislocation: a medium-term follow-up. Am J Sports Med. Feb 2005;33(2):220-30. [Medline].

  33. Mäenpää H, Lehto MU. Surgery in acute patellar dislocation--evaluation of the effect of injury mechanism and family occurrence on the outcome of treatment. Br J Sports Med. Dec 1995;29(4):239-41. [Medline]. [Full Text].

  34. Cossey AJ, Paterson R. A new technique for reconstructing the medial patellofemoral ligament. Knee. Apr 2005;12(2):93-8. [Medline].

  35. Mikashima Y, Kimura M, Kobayashi Y, Asagumo H, Tomatsu T. Medial patellofemoral ligament reconstruction for recurrent patellar instability. Acta Orthop Belg. Dec 2004;70(6):545-50. [Medline].

  36. Wu LS. Evaluation and manipulative therapy of patellar malalignment: a clinical review and preliminary report. J Manipulative Physiol Ther. Sep 1991;14(7):428-35. [Medline].

  37. Brosseau L, Casimiro L, Robinson V, et al. Therapeutic ultrasound for treating patellofemoral pain syndrome. Cochrane Database Syst Rev. 2001;CD003375. [Medline]. [Full Text].

  38. Atkin DM, Fithian DC, Marangi KS, et al. Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury. Am J Sports Med. Jul-Aug 2000;28(4):472-9. [Medline].

  39. Hinton RY, Sharma KM. Acute and recurrent patellar instability in the young athlete. Orthop Clin North Am. Jul 2003;34(3):385-96. [Medline].

  40. Cash JD, Hughston JC. Treatment of acute patellar dislocation. Am J Sports Med. May-Jun 1988;16(3):244-9. [Medline].

  41. Beaconsfield T, Pintore E, Maffulli N, Petri GJ. Radiological measurements in patellofemoral disorders. A review. Clin Orthop Relat Res. Nov 1994;308:18-28. [Medline].

  42. Beasley LS, Vidal AF. Traumatic patellar dislocation in children and adolescents: treatment update and literature review. Curr Opin Pediatr. Feb 2004;16(1):29-36. [Medline].

  43. BenGal S, Lowe J, Mann G, Finsterbush A, Matan Y. The role of the knee brace in the prevention of anterior knee pain syndrome. Am J Sports Med. Jan-Feb 1997;25(1):118-22. [Medline].

  44. Bensahel H, Souchet P, Pennecot GF, Mazda K. The unstable patella in children. J Pediatr Orthop B. Oct 2000;9(4):265-70. [Medline].

  45. Boden BP, Pearsall AW, Garrett WE Jr, Feagin JA Jr. Patellofemoral Instability: Evaluation and Management. J Am Acad Orthop Surg. Jan 1997;5(1):47-57. [Medline].

  46. Brody LT, Thein JM. Nonoperative treatment for patellofemoral pain. J Orthop Sports Phys Ther. Nov 1998;28(5):336-44. [Medline].

  47. Chapman MW, ed. Chapman's Orthopaedic Surgery. Vol 2. 3rd ed. Baltimore, Md: Lippincott Williams & Wilkins; 1993.

  48. [Best Evidence] Christiansen SE, Jakobsen BW, Lund B, Lind M. Isolated repair of the medial patellofemoral ligament in primary dislocation of the patella: a prospective randomized study. Arthroscopy. Aug 2008;24(8):881-7. [Medline].

  49. Connolly JF. Fractures and Dislocations: Closed Management. Philadelphia, Pa: WB Saunders Co; 1995.

  50. Eckstein F, Adam C, Sittek H, et al. Non-invasive determination of cartilage thickness throughout joint surfaces using magnetic resonance imaging. J Biomech. Mar 1997;30(3):285-9. [Medline].

  51. Eckstein F, Schnier M, Haubner M, et al. Accuracy of cartilage volume and thickness measurements with magnetic resonance imaging. Clin Orthop Relat Res. Jul 1998;352:137-48. [Medline].

  52. Elias DA, White LM. Imaging of patellofemoral disorders. Clin Radiol. Jul 2004;59(7):543-57. [Medline].

  53. Fithian DC, Paxton EW, Cohen AB. Indications in the treatment of patellar instability. J Knee Surg. Jan 2004;17(1):47-56. [Medline].

  54. Fulkerson JP. Alternatives to patellofemoral arthroplasty. Clin Orthop Relat Res. Jul 2005;436:76-80. [Medline].

  55. Gagliardi JA, Chung EM, Chandnani VP, et al. Detection and staging of chondromalacia patellae: relative efficacies of conventional MR imaging, MR arthrography, and CT arthrography. AJR Am J Roentgenol. Sep 1994;163(3):629-36. [Medline]. [Full Text].

  56. Grelsamer RP, Klein JR. The biomechanics of the patellofemoral joint. J Orthop Sports Phys Ther. Nov 1998;28(5):286-98. [Medline].

  57. Grood ES, Suntay WJ, Noyes FR, Butler DL. Biomechanics of the knee-extension exercise. Effect of cutting the anterior cruciate ligament. J Bone Joint Surg Am. Jun 1984;66(5):725-34. [Medline].

  58. Handelberg F, Shahabpour M, Casteleyn PP. Chondral lesions of the patella evaluated with computed tomography, magnetic resonance imaging, and arthroscopy. Arthroscopy. 1990;6(1):24-9. [Medline].

  59. Handelberg F, Shahabpour M, Van Betten F, et al. CT arthrography and MRI of the patella. Acta Orthop Belg. 1989;55(3):331-8. [Medline].

  60. Hawkins RJ, Bell RH, Anisette G. Acute patellar dislocations. The natural history. Am J Sports Med. Mar-Apr 1986;14(2):117-20. [Medline].

  61. Holmes SW Jr, Clancy WG Jr. Clinical classification of patellofemoral pain and dysfunction. J Orthop Sports Phys Ther. Nov 1998;28(5):299-306. [Medline].

  62. Ireland ML, Chang JL. Acute fracture bipartite patella: case report and literature review. Med Sci Sports Exerc. Mar 1995;27(3):299-302. [Medline].

  63. King JB, Perry DJ, Mourad K, Kumar SJ. Lesions of the patellar ligament. J Bone Joint Surg Br. Jan 1990;72(1):46-8. [Medline]. [Full Text].

  64. Kujala UM, Osterman K, Kormano M, et al. Patellofemoral relationships in recurrent patellar dislocation. J Bone Joint Surg Br. Nov 1989;71(5):788-92. [Medline]. [Full Text].

  65. Leblanc JM. Patellar complications in total knee arthroplasty. A literature review. Orthop Rev. Mar 1989;18(3):296-304. [Medline].

  66. Levine J. Chondromalacia patellae. Physician Sportsmed. 1979;7:41-9.

  67. Lindberg U, Lysholm J, Gillquist J. The correlation between arthroscopic findings and the patellofemoral pain syndrome. Arthroscopy. 1986;2(2):103-7. [Medline].

  68. Mangine RE, Eifert-Mangine M, Burch D, Becker BL, Farag L. Postoperative management of the patellofemoral patient. J Orthop Sports Phys Ther. Nov 1998;28(5):323-35. [Medline].

  69. Miller MD, Hinkin DT, Wisnowski JW. The efficacy of orthotics for anterior knee pain in military trainees. A preliminary report. Am J Knee Surg. Winter 1997;10(1):10-3. [Medline].

  70. Miller PR, Klein RM, Teitge RA. Medial dislocation of the patella. Skeletal Radiol. 1991;20(6):429-31. [Medline].

  71. Moore KL. Clinically Oriented Anatomy. 3rd ed. Baltimore, Md: Lippincott Williams & Wilkins; 1992.

  72. Mow VC, Ateshian GA, Ratcliffe A. Anatomic form and biomechanical properties of articular cartilage of the knee joint. J Biomech Eng. 1991;113(2):198-207.

  73. Mäenpää H, Lehto MU. Patellar dislocation has predisposing factors. A roentgenographic study on lateral and tangential views in patients and healthy controls. Knee Surg Sports Traumatol Arthrosc. 1996;4(4):212-6. [Medline].

  74. Nissen CW, Cullen MC, Hewett TE, Noyes FR. Physical and arthroscopic examination techniques of the patellofemoral joint. J Orthop Sports Phys Ther. Nov 1998;28(5):277-85. [Medline].

  75. Nomura E, Inoue M, Kurimura M. Chondral and osteochondral injuries associated with acute patellar dislocation. Arthroscopy. Sep 2003;19(7):717-21. [Medline].

  76. Powers CM. Rehabilitation of patellofemoral joint disorders: a critical review. J Orthop Sports Phys Ther. Nov 1998;28(5):345-54. [Medline].

  77. Powers CM, Shellock FG, Beering TV, et al. Effect of bracing on patellar kinematics in patients with patellofemoral joint pain. Med Sci Sports Exerc. Dec 1999;31(12):1714-20. [Medline].

  78. Rauschning W, Nordesjö LO, Nordgren B. Isokinetic knee extension strength and pain before and after correction of recurrent patellar dislocation. Arch Orthop Trauma Surg. 1983;102(2):102-6. [Medline].

  79. Sanders TG, Morrison WB, Singleton BA, Miller MD, Cornum KG. Medial patellofemoral ligament injury following acute transient dislocation of the patella: MR findings with surgical correlation in 14 patients. J Comput Assist Tomogr. Nov-Dec 2001;25(6):957-62. [Medline].

  80. Schonholtz GJ, Zahn MG, Magee CM. Lateral retinacular release of the patella. Arthroscopy. 1987;3(4):269-72. [Medline].

  81. Shellock FG. Effect of a patella-stabilizing brace on lateral subluxation of the patella: assessment using kinematic MRI. Am J Knee Surg. Summer 2000;13(3):137-42. [Medline].

  82. Shellock FG. Patellofemoral joint abnormalities in athletes: evaluation by kinematic magnetic resonance imaging. Top Magn Reson Imaging. Sep 1991;3(4):71-95. [Medline].

  83. Tecklenburg K, Dejour D, Hoser C, Fink C. Bony and cartilaginous anatomy of the patellofemoral joint. Knee Surg Sports Traumatol Arthrosc. Mar 2006;14(3):235-40. [Medline].

  84. Wessel LM, Scholz S, Rüsch M. Characteristic pattern and management of intra-articular knee lesions in different pediatric age groups. J Pediatr Orthop. Jan-Feb 2001;21(1):14-9. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

patellar injury and dislocation, patellofemoral dysfunction, patellofemoral dislocation, patella subluxation, patellofemoral joint dysfunction, patellofemoral joint syndrome, patellofemoral pain, patellofemoral pain syndrome, PFPS, patellofemoral stress syndrome, PFSS, kneecap injury, dislocated kneecap, knee pain, knee injury, knee dislocation, dislocated knee, patella fracture, knee fracture

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Gerard A Malanga, MD, Founder and Director, New Jersey Sports Medicine Institute; Director of Pain Management, Overlook Hospital; Director of Sports Medicine, Sports Medicine Fellowship Director, Mountainside Hospital; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Medical Director, Consultant, Horizon Healthcare Worker's Compensation Services, Blue Cross and Blue Shield Worker's Compensation
Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Coauthor(s)

Brian F White, DO, Staff Physician, Department of Physical Medicine and Rehabilitation, Kessler Institute for Rehabilitation, University of Medicine and Dentistry of New Jersey
Brian F White, DO is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Osteopathic Association, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Wah Sang Lee, DO, MS, Staff Physician, Department of Physical Medicine and Rehabilitation, New Jersey Medical School/Kessler Institute of Rehabilitation
Wah Sang Lee, DO, MS is a member of the following medical societies: American Osteopathic Association
Disclosure: Nothing to disclose.

Thomas Agesen, MD, Assistant Clinical Professor, Department of Physical Medicine and Rehabilitation, UMDNJ, New Jersey Medical School; Consulting Staff, Mountainside Hospital, Summit Overlook Hospital
Thomas Agesen, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Medical Editor

Andrew L Sherman, MD, MS, Associate Professor of Clinical Rehabilitation Medicine, Vice Chairman, Chief of Spine and Musculoskeletal Services, Program Director, SCI Fellowship and PMR Residency Programs, Department of Rehabilitation Medicine, Leonard A Miller School of Medicine, University of Miami
Andrew L Sherman, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Sports Medicine, American Medical Association, American Paraplegia Society, American Spinal Injury Association, and Association of Academic Physiatrists
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Russell D White, MD, Professor of Medicine, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.