Patellofemoral pain - tutorials - by Dr Ronald Grelsamer

 

Dr ronald grelsamer

 

 

In this section Dr Ronald Grelsamer of the Mount Sinai Hospital in New York presents a series of tutorials on the very important topic of patellofemoral pain.

 

 

 

 

Part 1 - Anatomy

  • Examining your own kneecap
  • Bones and muscles
  • Patellar tendon

Part 2 - Important concepts

  • Q-angle
  • Malalignment
  • Tilt
  • Tender facets
  • Suprapatellar pouch

Part 3 - Differential diagnosis

  • Conditions interfering with the mechanics of the knee
  • Knee problems not necessarily involving the mechanics of the knee
  • 'Complex Regional Pain Syndrome'
  • 'Referred Pain', not originating with the knee at all

Part 4a - Conditions interfering with the mechanics of the knee

  • Tight structures around the knee
  • Loose structures around the knee
  • Factors increasing the Q-angle
  • Overuse
  • Deformed bones
  • Stressed bones

Part 4b - Conditions NOT interfering with the mechanics of the knee

  • Knee problem but not necessarily involving the extensor mechanism
  • Complex regional pain syndrome
  • Referred pain from the hip and spine

Part 5a - History

  • The nature of the injury
  • The nature of the discomfort
  • History of swelling
  • Noises in the knee
  • Pseudolocking, instability, catching

Part 5b - Examination

  • Examination standing
  • Sitting at the edge of the examination table
  • Supine (lying on one's back)
  • Prone (lying on one's stomach)
  • Decubitus position (lying on one's side)

Part 6 - Imaging and X-rays

  • X-rays
  • AP and Lateral X-rays
  • X-ray quality
  • Blumensaat's line
  • Merchant's view

Part 7 - Non-operative treatment

  • Preventing Overuse
  • Mechanical support and improvement of posture
  • Releasing tight structures on the lateral side
  • Improving Muscle Balance
  • Relieving local inflammation
  • Artificial lubricants -Synvisc
  • Diet & nutritional supplements

Part 8 - Surgery for Patellar Mal-alignment

  • Releasing tight structures on the lateral side
  • Tightening incompetent structures on the medial side
  • Repositioning of the tibial tubercle

Part 9 - Surgery to slow established patellofemoral arthritis

  • Cartilage restoration
  • Patello-femoral resurfacing
  • Patellectomy

Part 10 - Glossary