chapter 3: History and Physical Examination

PHYSICAL EXAMINATION

It is not possible to adequately treat patients with patellofemoral disorders without mastering patellofemoral physical examination. The goals of examination in patients suspected of having patellofemoral disorders are: (1) to assess factors that affect articular and retinacular forces and alignment; and (2) to locate the painful soft tissue or articular structures. The purpose of this discussion is not to present a comprehensive "laundry list" of examination maneuvers, but rather to present a logical, focused and efficient approach to physical examination. Once mastered, an adequate examination will usually take at least 5 minutes and not only confirms the diagnosis of a patellofemoral problem but, as we will see, helps focus and direct nonoperative and operative treatment.

Most of the tests to be discussed have not been vigorously studied in normal age-matched populations. Inter‑examiner/intra‑examiner variability is unknown for many tests. The reader must understand and accept these limitations. During the discussion of tests for which background research exists, such data will be reviewed. We are unaware of such information for all the other tests. Nonetheless, examination criteria to be presented have been developed by the careful observation of generations of clinicians and have stood the test of time. Both legs should be examined. Frequently differences will be found and, if asymptomatic, a contralateral extremity provides some measure of clinical control. In order to allow a natural progression through the entire examination, the presentation will be as it is practiced in a busy orthopedic surgeon's office.

 

 

 

 

 

        

Inside Chapter 3: