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

Common

Less Common

Critical Conditions

Patellofemoral pain

Sinding-Larsen-Johansson lesion

Synovial plica

Patellar tendinopathy

Osgood-Schlatter lesion

Osteochondritis dissecans

Fat pad impingement

Quadriceps tendinopathy

Tumour (especially in young)

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.