So, Patellofemoral syndrome,
let’s put that on the spotlight
because it is really important.
It is the most common
cause of anterior knee pain,
both in general and among athletes specifically.
The classic is that movie sign.
You’re in a movie for two hours or so.
You first stand up,
it's really stiff,
you walk a little bit,
that anterior knee pain gets better.
Also another one that’s
worse with climbing stairs,
but unlike the iliotibial band,
this is going to be more of a
central pain under the patella
and kind of hard to describe.
It's usually a dull pain
and kind of vague,
but it can be really debilitating as well.
Doesn't mean it's always so
benign or a mild type pain.
I’ve seen mild to severe patellofemoral
syndrome pain as well.
On exam, one of the interesting things,
and this might be on your exam,
is the J sign.
So, as the knee is extended from 90° to full flexion,
there will be a lateral patellar tracking.
There is patellar laxity
in a lot of these cases.
So, you’ll actually see that the
patella migrate more laterally.
And so, of course,
you’re going to check for
the stability of the patella.
Patients with patellofemoral syndrome are more likely
to have a little bit more laxity in their patella.
You don't really need x-rays
among these patients if you have –
particularly when you have
these other findings,
the symptoms and the signs all
suggest patellofemoral syndrome.
So, again, rest is important.
And it's important to actually recommend
physical therapy for these patients.
And I was always of the mind,
well, it’s always just
about quad strengthening.
Actually sometimes quad strength in
these patients is absolutely perfect.
It's just that they are too tight
over that complex of muscles,
and so therefore,
they actually need more stretching.
And a physical therapist
can be really helpful
in determining which particular types
of exercises your patient needs.
There is less evidence,
however, for things like knee
braces or patellar taping.
So, physical therapy on the exam
would be the right answer
if you had a list of potential interventions
for patellofemoral syndrome.
And I have to mention osteoarthritis because
among patients who are 50 and over,
this is going to be the most
common cause of knee pain.
So, certainly, think about exercise therapy
for these individuals as well.
Generally, weight loss is certainly going to help
and exercise therapy can really help
to help stabilize the joint and, therefore,
reduce pain in everyday activities.
As I’ve mentioned for other
acetaminophen has better safety,
but is probably slightly less
effective than NSAIDs overall,
but I still use acetaminophen as my first go-to drug
in cases where patients haven't tried anything for it.
Glucosamine and chondroitin are commonly used.
They are very much promoted for osteoarthritis.
They have a pretty mixed record of efficacy overall.
There's few studies that have
shown that they’ve worked.
And the studies of higher quality
tend to show no improvement.
That said, in my clinical practice,
I can say that patients really
like glucosamine in particular.
They think it works great.
So, that was an introduction to knee pain
and some of its common causes.
I think as you review,
just think about those atypical causes.
Those are going to be the ones
that come up on the exam,
less so osteoarthritis.
But iliotibial band syndrome,
those are things you should
know something about
and be ready to answer for
because you could well see them coming up.