ABSTRACT
Patellofemoral pain is characterized by insidious onset anterior knee pain that is exaggerated under conditions of increased patellofemoral joint stress. A variety of risk factors may contribute to the development of patellofemoral pain. It is critical that the history and physical examination elucidate those risk factors specific to an individual in order to prescribe an appropriate and customized treatment plan. This article aims to review the epidemiology, risk factors, diagnosis, and management of patellofemoral pain.
Subject(s)
Pain Management/methods , Patellofemoral Joint/injuries , Patellofemoral Pain Syndrome/diagnosis , Patellofemoral Pain Syndrome/therapy , Running/injuries , Biomechanical Phenomena , Humans , Pain Measurement , Physical Therapy Modalities , Risk FactorsSubject(s)
Athletes , Athletic Injuries/diagnosis , Chest Pain/etiology , Fractures, Stress/diagnosis , Intercostal Muscles , Rib Fractures/diagnosis , Sprains and Strains/diagnosis , Adolescent , Athletic Injuries/complications , Basketball , Diagnosis, Differential , Female , Fractures, Stress/complications , Golf/injuries , Humans , Male , Posture , Rib Fractures/complications , Sprains and Strains/complications , Young AdultABSTRACT
Patellofemoral pain syndrome (PFPS) is a multifactorial disorder with a variety of treatment options. The assortment of components that contribute to its pathophysiology can be categorized into local joint impairments, altered lower extremity biomechanics, and overuse. A detailed physical examination permits identification of the unique contributors for a given individual and permits the formation of a precise, customized treatment plan. This review aims to describe the latest evidence and recommendations regarding rehabilitation of PFPS. We address the utility of quadriceps strengthening, soft tissue flexibility, patellar taping, patellar bracing, hip strengthening, foot orthoses, gait reeducation, and training modification in the treatment of PFPS.
Subject(s)
Patellofemoral Pain Syndrome/rehabilitation , Biomechanical Phenomena/physiology , Braces , Compression Bandages , Humans , Muscle Strength , Resistance Training/methodsABSTRACT
A 17-year-old female with type 1 Von Willebrand Disease (vWD) developed left medial calf pain while running track. Over the next 6 months, orthopedic surgery, sports medicine, vascular surgery, and neurology treated her under various working diagnoses; however, the pain, allodynia, coldness, and pale skin color worsened. She was admitted to a tertiary pediatric hospital for intractable pain where PM&R diagnosed her with complex regional pain syndrome (CRPS) type 1, began gabapentin, and initiated an aggressive inpatient rehabilitation program. During her 3 weeks of inpatient rehabilitation, passive range of motion of knee extension improved from 40° from extension to full extension, and ankle dorsiflexion improved from 15° from neutral to a consistent range of motion beyond neutral. Additional outcome measures were distance of ambulation and assistive device usage; from admission to inpatient rehabilitation to 2 months postdischarge, her weight-bearing tolerance progressed from nonweight-bearing to partial weight-bearing, and ambulation improved from 20 feet with a three-point crutch gait to unlimited distances with a four-point crutch gait. This is the first known case of a bleeding disorder as the likely underlying microvascular pathology associated with CRPS, a theory exposed in 2010.
Subject(s)
Athletes , Complex Regional Pain Syndromes/diagnosis , Running , von Willebrand Diseases/diagnosis , Adolescent , Complex Regional Pain Syndromes/complications , Female , Humans , Leg/pathology , von Willebrand Diseases/complicationsABSTRACT
OBJECTIVE: To evaluate the capabilities and resources of free and charitable clinics in the United States to deliver musculoskeletal care to an indigent population. DESIGN: A voluntary, anonymous, cross-sectional survey. SETTING: Electronic mailing list for the National Association of Free and Charitable Clinics in September 2011, and in person at the Annual Summit for the National Association of Free and Charitable Clinics in October 2011. At the time of survey, 427 member-clinics were eligible for participation. PARTICIPANTS: One hundred forty-five (34%) respondents were included in data analysis. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Answers to a questionnaire regarding access to musculoskeletal care. RESULTS: The average annual clinic volume was 5690 patient visits. Low back pain was the most common orthopedic complaint. Access to musculoskeletal specialty consultants was rated as poor or worse in 83% of clinics surveyed. The majority of respondents (63%) believed that their staff was able to treat only half or fewer of the patients who presented with musculoskeletal complaints in their clinic. The resource most needed to treat these conditions was musculoskeletal physician consultants. CONCLUSIONS: Indigent populations have a strong need for musculoskeletal care, but affordable access to physiatrists and other musculoskeletal specialists is extremely limited. Personnel at surveyed clinics believed that the greatest need to improve care is better access to these specialty physicians.
