EXAMINATION OF THE PATELLOFEMORAL JOINT

Abstract

Patellofemoral pain is one of the leading causes of knee pain in athletes. The many causes of patellofemoral pain make diagnosis unpredictable and examination and treatment difficult. This clinical commentary discusses a detailed physical examination routine for the patient with patellofemoral pain. Critically listening and obtaining a detailed medical history followed by a clearly structured physical examination will allow the physical therapist to diagnose most forms of patellofemoral pain. This clinical commentary goes one step further by suggesting an examination scheme and order in which it should be performed during the examination process. This step-by-step guide will be helpful for the student or novice therapist and serve as review for those that are already well versed in patellofemoral examination.

Keywords: Patellofemoral assessment and Clinical reasoning; evaluation.

Figure 1.

Descending a step using an eccentric contraction of the quadriceps can cause patellar pain due to increased compressive loads placed upon the articular cartilage of the posterior patellar facets.

Figure 2.

Anterior view can be used to assess valgus/varus angulation of knee, coxa valga/vara and overall patellar position.

Figure 3.

Posterior view can be used to assess valgus/varus angulation of the knee, and to assess forefoot, mid-tarsal, and subtalar joint position.

Figure 4.

Lateral view can be used to assess for genu recurvatum, knee flexion contracture, and patella alta or baja.

Figure 5.

Palpation of the iliac crest to examine for pelvis height. Higher iliac crest could indicate a longer leg, while a lower iliac crest could indicate a shorter leg.

Figure 6.

Measurement of standing leg length measurement taken with flexible tape measure from anterior superior iliac spine to medial malleolus. A difference in length of limbs greater than 1.5 cm is thought to be pathologic.

Figure 7.

Weber-Barstow measurement comparing position of malleoli in supine (a) and long sitting (b).

Figure 8.

Excessive pronation seen as medial arch collapse in relaxed standing.

Figure 9.

Assessment of subtalar joint in weight bearing functional position. Clinician will palpate the head of the talus on the dorsal medial aspect of the right foot with the finger and the talar dome on the lateral foot with the thumb.

Figure 10.

The step-down test is performed to test hip and leg strength and endurance. Patient stands with arms folded across chest as they lower themselves in a slow and controlled manner until heel touches the floor.

Figure 11.

Single-leg squat with proper form and good control.

Figure 12.

Single-leg squat with compensatory increased ipsilateral trunk lean.

Figure 13.

Single-leg squat with compensatory increased contralateral pelvic drop.

Figure 14.

Single-leg squat with compensatory hip adduction and knee abduction.

Figure 15.

Passive (a) and active (b) patellar tracking.

Figure 16.

Standing stork test for static balance deficits

Figure 17.

90/90 leg raise test for hamstring flexibility.

Figure 18.

Sitting hamstring flexibility test

Figure 19.

Examination test to assess for medial patellar glide performed in 30 degrees of knee flexion that assess for limitation of mobility in the superficial lateral patellar retinaculum.

Figure 20.

Examination test to assess for superior patellar glide performed in 30 degrees of knee flexion that assess the limitation of mobility of the inferior patellar tendon and soft tissue structures.

Figure 21.

Examination tests to assess for inferior patellar glide performed in 30 degrees of knee flexion that assess the limitation of mobility of the Quadriceps tendon and other quadriceps muscles.

Figure 22.

The moving patellar apprehension test is done with the patient supine The clinician translates the patella laterally while moving from a extended to a flexed position A positive test is indicated by symptoms of instability with this test.

Figure 23.

Examination test to determine patellar tilt for assessment of the deep patellar retinacular fibers. Test for tightness of deep lateral structures is done by attempting to tilt in a medial direction. Inability to obtain a neutral position indicates tightness of deep lateral structures.

Figure 24.

Ely's prone test for rectus femoris flexibility is done with hip in neutral extension.