Physical Examination of_Overuse_Chronic_Knee_conditions_2023

University Information

• Institution: Australian Catholic University (ACU)

• Course Title: Physical Examination of Overuse/Chronic Knee Conditions

• Semester: Semester 1

• Lecturer: Shreya McLeod

Copyright Notice

• Copyright: Commonwealth of Australia Copyright Act 1968

  • Material reproduced as per SECTION 113P of the Copyright Act 1968.

  • Reproduction or communication of this material may be copyright protected.

Learning Objectives

• Students will be able to:

  • Describe the aetiology and clinical presentation of common non-acute knee conditions.

  • Describe clinical presentation of selected (less common) knee pathologies for differential diagnosis.

  • Interpret findings from patient interviews to plan appropriate physical examinations.

  • Confirm or exclude overuse knee conditions through physical examination findings.

  • Recognize appropriate radiological investigations for knee region.

Physical Examination Components

Observation

• Positions: Standing, Gait, Supine

Movement Assessments

• Functional Tests:

  • Squat (Double Leg and Single Leg)

  • Lunge

  • Jump/Hop

  • Stairs

  • Running

  • Drop Down

• Passive and Active Movements:

  • Assess patella and tendons (medial/lateral facets, retinaculum, tendons)

  • Knee flexion and extension

  • Tibial internal/external rotation

Palpation

• Palpate various knee structures:

  • Patella tendon (proximal, mid, distal)

  • Quadriceps tendon

  • Hoffa's fat pads

  • Lateral femoral condyle

  • Superior tibiofibular joint and more...

Special Tests

• Specific assessments to differentiate knee conditions:

  • McConnell Resisted Extension Test

  • Neurodynamic tests (SLR, Slump test)

  • Examination of lumbar spine, hip joint, and ankle joint

Common Knee Pain Conditions

Anterior Knee Pain

Definition of Patellofemoral Pain

• Description: Umbrella term for peripatellar or retropatellar pain without other pathologies.

• Epidemiology: Most common knee condition affecting 22 out of 1000 people annually.

• Synonyms: PF joint pain, PF pain syndrome, chondromalacia patellae.

Pathogenesis of Patellofemoral Pain Syndrome (PFPS)

• Can be caused by:

  • Increased stress to the patella and retinacula.

  • Maltracking of the patella.

  • Dynamic valgus, hip muscle dysfunction, etc.

Contributing Factors for Patellofemoral Pain (PFP)

• Extrinsic Factors:

  • Increased PFJ load due to body mass, surfaces, footwear, etc.

• Intrinsic Factors:

  • Patella alignment and tracking, reduced muscle strength.

Patella Positioning

• Types of Malposition:

  • Lateral displacement, tilt issues, patella alta (high riding).

Quadriceps as a Local Factor in PFP

• Issues Related to Quadriceps:

  • Reduced extension torque, atrophy, delayed muscle activation, reduced flexibility, and altered contact forces.

Remote Factors Impacting PFP

• Biomechanical Factors:

  • Increased femoral internal rotation, hip adduction, and knee valgus.

Functional Assessment of Pain

• Assess activities causing pain:

  • Squatting, lunging, running, etc.

Patellar Tendinopathy Overview

• Definition: Overuse condition leading to degeneration of the patellar tendon, notable in athletes.

• Mechanism of Injury: Repetitive mechanical loading and sudden increases in exertion.

• Symptoms: Pain over the patellar tendon, stiffness, especially in the morning or after rest.

Differential Diagnosis between Patellar Tendinopathy and Other Conditions

• Common Signs: Locally increased tenderness, possible thickening of tendon, and associated functional limitations.

Less Common Knee Conditions

Hoffa's Fat Pad Impingement

• Description: Pain-sensitive structure trapped between patella and femoral condyle; linked to acute and chronic injuries.

Osgood-Schlatter Disease

• Overview: Condition seen in adolescents characterized by pain at the tibial tuberosity due to growth spurts and repetitive quadriceps contraction.

Sinding-Larsen-Johansson Syndrome

• Condition Characteristics: Similar to Osgood-Schlatter but occurs at the inferior pole of the patella.

Conclusion

• Clinical Importance: Recognizing various knee pathologies is essential for appropriate management and treatment planning to address symptoms and improve patient quality of life.