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PFPS treatment

Terms in this set (46)

Tx for PF
quad and glut med and max strengtheing
stetching (ITB, hams, quads, rectus, iliopsoas, LR)
bracing
orthotics
patella taping
activity modification
functional motor learning
modalities
REST
principles
everything should be painfree
restore mobility prior to strengthening
encourage good patellar tracking
motor learning > muscle strengthening
low load exercises
minimize PF contact stress
treat entire kinetic chain
patient education is critical
avoid isokinetics
SAID
what should be avoided in PF pts?
weighting them down (adding pf reaction forces)
isokinetics
TKE
sitting for a long time
no squats, no stairs
What causes inhabition of the quads?
neurogenic inhabition
arthrogenic inhibition
neurogeneic inibition
pain inhibits mm function
arthrogenic inhibition
joint effusion inhibits mm funciton
60mls of saline in the joint inhibits the quads by 50%
TKE or SAQ
NO!
how does a lateral step up or down differ from forward?
forward requires more knee flexion
increased
Lateral step up
better then forward at the same box height
less stress
forward step up
use smaller box
better then forward step down
Wall squats
feet shoulder width apart
knees over 2nd metatarsal
Prone don tigne
reverse TKE
encourages cocontraction of quads/hams/glut max
mixed but more closed chain
In the closed kinetic chain which causes more of a problem with abnormal pf arthrokinimatic movements the femur or the patella?
the femur
in the closed kinetic chain it is the femur moving on the fixed patella
glut med strengthening
make sure you have ER of the hip and extension
watch for adduction and IR of the femur on step down correct by maintaing glut med contraction with step down
Which is better for pain relief OKC or CKC exercises?
no preference if they are done in the correct range
OKC exercises
45-90
CKC exercises
0-45
What area of the body should be targeted to get PFPS patients better faster hip or quads?
target the hip
they both got better only the hip focus got better faster
protonic brace
has springs hinges in the knee and tries to extend the knee
the person has to contract the hamstring to fight the brace
it facilitates contraction of the hamstring
causes a posterior pelvic tilt and internal rotation of the femur
reduces lateral patella compression
Palumbo brace
neoprene sleve with felt buttresses that is meant to hold the patella in place and improve tracking
doesn't work
may cause patella compression
modalitites
best for the soft tissue
iontophoresis (structures are too deep for ionto)
phonophoresis
ultrasound pre-stretch
patella taping
has a great short term effect on pain which allows the pt to exercise pain free
McConnell taping study on patellar shifting
not only control medial and lateral glide but also causes a inferior shift of the patella which increases contact area and decreases force
most effective tx for PF
acupunture
acute primary patella dislocation: treatment prognosis
normal intrinsic biomechancis with traumatic dislocation - good conservative care response
dysplastic = poor prognostic conservative care prognosis
What are the indications following dislocation?
1. osteochondral fracture of lateral femoral condyle
2. age less then 14
3. highly active/ competative atheletes
4. palpable medial vastus defect ( tear mm too)
5. contralateral evidence of dysplasia
6. family history
7. patella alta
Tx of primary dislocation
immobilizer or knee brace for max 7-10 days
modalitities
ROM as tolerated
strengthening as tolerated
When is Sx indicated
osteochondral fracture
extensor mechanism is disrupted
failure of conservative management
What position is the patella the most stable? Do we immobilize PF patients in that position?
flexion
No don't want a knee flexion contracture
Where do you want to perform exercises?
not in extension because that is where the patella is the least stable. So we need to exercise open kinetic chain between 45-90.
When can you use arthroscopic debridement
no malalignment
mild fibrillation of articular cart
hypertrophic medial plica
chondral flaps
Nail-Patella syndrome
dysplastic, hypoplastic, or absent patella
dysplastic fingernails
glaucoma
kidney dz
proximal re-alignment types
soft tissue procedure that moves the patella anterior and medial
1) lateral retinacular release
2) medial imbrication
medial imbrication
reconstruction of medial PF ligament
Distal re-alignment
Bony procedure
1) medialization
2) Anteromedialization
Lateral retinacular release
significant lateral tilt (will not do this for decreased medial glide)
outerbridge grade I and II
What is important with a lateral release
post op there is alot of motion to the medial direction but as it heals the lateral retinaculum will begin to scar down
end result: patella medial glide is stightly greater then neutral
AMZ
Structural malaignment (sublux or instability)
only done in pt that is skeletally mature
severe articular pathology (outerbridge III and IV)
What does an AMZ do?
increases the load on the proximal medial facet which usually is not affect by arthorosis
When is an AMZ not recommended
pts with dashboard injuries to the proximal patella
pts with arthritic changes in the superior lateral facet
When is a critical period for the AMZ
first 6 weeks while the shingle is only held down with bone to bone healing and screws
With OA and subluxation how would you want to move the patella
OA - anterior
Sublux - medialization
AMZ rehab
locked in full extension
no ckc knee flexion
ok AROM (heel slides) because controlled by hamstring
quad sets
When do you use patellar replacement "resurfacing"
grade III or IV articular cartilage pathology
those with poor quad function
complication patella fracture and prothesis
Reconstruction of the medial PF ligament
congenital dislocation
children
uses posterior 1/3 of semitendonosus routed under the MCL to the medial patella to reconstruct the medial PF ligament
patellectomy
last choice procedure
older pt that are less active
only patella involvement
THIS SET IS OFTEN IN FOLDERS WITH...