chapter 3: History and Physical Examination

REFERENCES

  1. de Andrade JR, Grant C, Dixon A StJ. Joint distension and reflex muscle inhibition in the knee. J Bone Joint Surg (Am) 1965;47A:313‑22.
  2. Kennedy JC, Alexander IJ, Hayes KC. Nerve supply of the human knee and its functional importance. Am J Sports Med 1982;10:329‑335.
  3. Spencer JD, Hayes KC, Alexander IJ: Knee joint effusion and quadriceps inhibition in man. Arch Phys Med Rehabil 1984;65:171‑177.
  4. Wood L, Ferrell WR, Baxendale RH: Pressures in normal and acutely distended human knee joints and effects on quadriceps maximal voluntary contractions. Q J Exp Physiol 1988; 73:305‑314.
  5. Bassett FH. Acute dislocation of the patella, osteochondral fractures and injuries to the extensor mechanism of the knee. Instr Course Lect 1976;25:40‑49.
  6. O'Brien SJ, Ngeow J, Gibney MA, Warren RF, Fealy S. Reflex sympathetic dystrophy of the knee: Causes, diagnosis and treatment. Am J Sports Med, 1995;23(6):655‑659.
  7. Post WR, Fulkerson JP. Knee pain diagrams: Correlation with physical examination findings in patients with anterior knee pain. Arthroscopy 1994;10(6):618‑623.
  8. Woodland LH, Francis RS. Parameters and comparisons of the quadriceps angle of college‑aged men and women in the supine and standing positions. Am J Sports Med 1992;20(2):208‑211.
  9. Olerud C, Berg P. The variation of the Q angle with different positions of the foot. Clin Orthop 1984;191:162‑165.
  10. Insall J, Falvo KA, Wise DW. Chondromalacia patellae: A prospective study. J Bone Joint Surg 1976;58A:1‑8.
  11. Aglietti P, Insall JN, Cerulli G. Patellar pain and incongruence.. Clin Orthop 1983;176:217‑224.
  12. Fairbank JCT, Pynsent PB, van Poortvliet JA, Phillips H. Mechanical factors in the incidence of knee pain in adolescents and young adults. J Bone Joint Surg 1984;66B:685‑693.
  13. Horton MG, Hall TL. Quadriceps femoris muscle angle: Normal values and relationships with gender and selected skeletal measures. Phys Therapy 1989;69(11):897‑901.
  14. Hsu RWW, Himeno S, Coventry MB, Chao EYS. Normal axial alignment of the lower extremity and load‑bearing distribution at the knee. Clin Orthop 1990;255:215‑227.
  15. Aglietti P, Insall JH, Cerulli G. Patellar pain and incongruence. Clin Orthop 1983;122:217‑224.
  16. Fithian DC, Mishra DK, Balen PF, Stone ML, Daniel DM. Instrumented measurement of patellar mobility. Am J Sports Med 1995;23(5):607‑615.
  17. Kujala UM, Dvist M, Osterman K, Friberg O, Aalto T: Factors predisposing army conscripts to knee exertion injuries incurred in a physical training program. Clin Ortho 1986;210:203‑212.
  18. Fulkerson JP, Hungerford DS. Disorders of the Patellofemoral Joint. 2nd ed. Baltimore, Md: Williams & Wilkins; 1990.
  19. Hughston JC, Walsh WM. Proximal and distal reconstruction of the extensor mechanism for patellar subluxation. Clin Orthop 1979;144:36‑42.
  20. Insall J, Falvo KA, Wise DW. Chondromalacia patellae, a prospective study. J Bone Joint Surg 1976;58A:1‑8.
  21. Perry J. Gait Analysis, Normal and Pathological Gait. Thorofare, NJ: Slack; 1992.
  22. Nichols PJR. Short‑leg syndrome. Br Med J 1960;1:1863‑1865.
  23. Rush WA, Steiner HA. A study of lower extremity length inequality. Am J Roentgenol 1946;56:616‑623.
  24. Sell KE, Verity TM, Worrell TW, Pease BJ, Wiglesworth J. Two measurements for assessing subtalar joint position: A reliability study. J Orthop Sports Phys Ther 1994;19:162‑176.
  25. Inman VT, Ralston HJ, Todd F. Human Walking. Baltimore, Md: Williams & Wilkins; 1981.
  26. Levens AS, Inman VT, Blosser JA. Transverse rotation of the segments of the lower extremity in locomotion. J Bone Joint Surg 1948;30A:859‑872.
  27. Tiberio D. The effect of excessive subtalar joint pronation on patellofemoral mechanics: A theoretical model. JOSPT 1987;(Oct):160‑165.
  28. Eng JJ, Pierrynowski MR. Evaluation of soft foot orthotics in the treatment of patellofemoral pain syndrome. Phys Ther 1993;73(2):62‑70.
  29. Gross MT. Lower quarter screening for skeletal malalignment‑suggestions for orthotics and shoewear. JOSPT 1995;21(6):389‑405.
  30. Hughston JC, Walsh WM, Puddu G. Patellar subluxation and dislocation. Philadelphia: WB Saunders; 1984.
  31. Kolowich PA, Paulos LE, Rosenberg TD, Farnsworth S. Lateral release of the patella: Indications and contraindications. Am J Sports Med 1990;18(4):359‑365.
  32. Muneta T, Yamamoto H, Ishibashi T, Asahina S, Furuya K. Computerized tomographic analysis of tibial tubercle position in the painful female patellofemoral joint. Am J Sports Med 1994;22(1):67‑71.
  33. Fulkerson JP, Gossling HR. Anatomy of the knee joint lateral retinaculum. Clin Orthop 1980;153:183‑188.
  34. Terry GC, Hughston JC, Norwood LA. The anatomy of the iliopatellar band and the iliotibial track. Am J Sports Med 1986;14(1):39‑45.
  35. Ficat P, Hungerford D. Disorders of the Patellofemoral Joint. 1st ed. Baltimore: Williams & Wilkins; 1977.
  36. Conlan T, Garth WP, Lemons JE. Evaluation of the medial soft‑tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg 1993;75A:682‑693.
  37. Sallay PI, Poggi J, Speer KP, Garrett WE. Acute dislocation of the patella, a correlative pathoanatomic study. Am J Sports Med 1996;24(1):52‑60.
  38. Kujala UM, Kvist M, Osterman K, et al. Factors predisposing army conscripts to knee exertion injuries incurred in a physical training program. Clin Orthop 1986;210:203‑212.
  39. Skalley TC, Terry GC, Teitge RA. The quantitative measurement of normal passive medial and lateral patellar motion limits. Am J Sports Med 1993;21:728‑732.
  40. Fitzgerald GK, McClure PW. Reliability of measurements obtained with four tests for patellofemoral alignment. Physical Therapy 1995;75(2):84‑89.
  41. Hughston JC, Deese M. Medial subluxation of the patella as a complication of lateral retinacular release. Am J Sports Med 1988;16:383‑388.
  42. Miller PR, Klein RM, Teitge RA. Medial dislocation of the patella. Skeletal Radiol 1991;20:429‑431.
  43. Teitge RA. Iatrogenic Medial Patellar Dislocation. AAOS Meeting, Anaheim, Calif.: 1991. AAOS Publications Rosemont, IL.
  44. Nonweiler DE, DeLee JC. The diagnosis and treatment of medial subluxation of the patella after lateral retinacular release. Am J Sports Med 1994;22(5):680‑686.
  45. Paulos LE, Wnorowski DC, Greenwald AE. Infrapatellar contracture syndrome. Diagnosis, treatment and long‑term follow‑up. Am J Sports Med 1994;22(4):440‑449.
  46. Riedert RM, Stauffer E, NF Friederich. Occurrence of free nerve endings in the soft tissue of the knee joint. Am J Sports Med 1992;20:430‑433.
  47. Fulkerson JP, Tennant R, Jaivin JS, et al. Histologic evidence of retinacular nerve injury associated with patellofemoral malalignment. Clin Orthop 1985;187:196‑205.
  48. Mori Y, Fujimoto A, Okumo H, Kuroki Y. Lateral retinaculum release in adolescent patellofemoral disorders: Its relationship to peripheral nerve injury in the lateral retinaculum. Bull Hosp Joint Dis 1991;51:218‑229.
  49. House JH, Ahmed K. Entrapment neuropathy of the infrapatellar branch of the saphenous nerve. Am J Sports Med 1977;5(5):217‑224.
  50. Luerssen TG, Campbell RL, Defalque RJ, Worth RM. Spontaneous saphenous neuralgia. Neurosurgery 1983;13(3):238‑241.
  51. Worth RM, Ketteldamp DB, Defalque RJ, Duane KU. Saphenous nerve entrapment: A cause of medial knee pain. Am J Sports Med 1984;12(1):80‑81.
  52. Carson WG, James SL, Larson RL, Singer KM, Winternitz WW. Patellofemoral disorders: Physical and radiographical examination. Clin Ortho 1984;185:165‑177.
  53. McCoy GF, McCrea JD, Beverland DE, Kernohan WG, Mollan RAB. Vibration arthrography as a diagnostic aid in diseases of the knee. J Bone Joint Surg 1987;69B:288‑293.
  54. Jiang CC, Liu YJ, Yip KM, Wu E. Physiological patellofemoral crepitus in knee joint disorders. Bull Hosp Joint Dis 1993;53(4):22‑26.
  55. Neely LA, Kernohan WG, Barr DA, Mee CHB, Mollan RAB. Optical measurements of physiological patellofemoral crepitus. Clin Phys Physiol Meas 1991;12(3):27.9‑226.
  56. Kernohan WG, Reverland DE, McCoy GF, et al: The diagnostic potential of vibration arthrography. Clin Ortho 1986;210:106‑112.
  57. Ruwe PA, Gage JR, Ozonoff MB, DeLuca PA. Clinical determination of femoral anteversion. J Bone Joint Surg 1992;74(A):820‑830.
  58. Yoshioka Y, Sin D, Cooke DV. The anatomy and functional axes of the femur. J Bone Joint Surg 1987;69(A):873‑880.
  59. Kingsley PC, Olmsted KL. A study to determine the angle of anteversion of the neck of the femur. J Bone Joint Surg 1.948;30(A):745‑751.
  60. Staheli LT, Corbett M, Wyss C, King H. Lower‑extremity rotational problems in children. J Bone Joint Surg 1985;67(A):39‑47.
  61. Brouwer KJ, Molenaar JC, van Linge B. Rotational deformities after femoral shaft fractures in childhood‑a retrospective study. Acta Orthop Scand 1981;52(1):81‑89.
  62. Briten M, Terjesen T, Rossvoll I. Femoral anteversion in normal adults. Acta Orthop Scand 1992;63(7.):29‑32.
  63. Melchione WE, Sullivan S. Reliability of measurements obtained by use of an instrument designed to indirectly measure iliotibial band length. JOSPT 1993;18(3):511‑515.
  64. Reid DC, Burnham RS, Saboe LA, Kushner SF. Lower extremity flexibility patterns in classical ballet dancers and their correlation to lateral hip and knee injuries. Am J Sports Med 1987;15(4):347‑352.
  65. Ober FR. The role of the iliotibial band and fascia lata as a factor in the causation of low‑back disability and sciatica. J Bone Joint Surg 1.936;18A:105‑110.
  66. Beighton P, Horan F. Orthopaedic aspects of the Ehlers Danlos Syndrome. J Bone Join Surg 1969;51B:444‑453.
  67. Rünow A. The dislocating patella: etiology and prognosis in relation to generalized joint laxity and anatomy of the patellar articulation. Acta Orthop Scand 1983;54:201(suppl).
  68. Stanitski CL. Articular hypermobility and chondral injury in patients with acute patellar dislocation. Am J Sports Med 1995;23(2):146‑150.
  69. Bonamo JJ, Fay C, Firestone T. The conservative treatment of the anterior cruciate deficient knee. Am J Sports Med 1990;18(6):618‑623.
  70. Buss DD, Min R, Skyhar MJ, et al. Conservatively treated anterior cruciate ligament injuries. Orthop Trans 1990;14:561.
  71. Keller PM, Shelbourne KD, McCarroll JR, Rettig AC. Nonoperatively treated isolated posterior cruciate ligament injuries. Am J Sports Med 1993;21(1):132‑136.
  72. Parolie JM, Bergfeld JA. Long‑term results of nonoperative treatment of isolated posterior cruciate ligament injuries in the athlete. Am J Sports Med 1986;14:35‑38.
  73. Lewallen DG, Riegger CL, Myers ER, Hayes WC. Effects of retinacular release and tibial tubercle elevation in patellofemoral degenerative joint disease. J Ortho Res 1990;8:856‑862.
  74. Fulkerson JP, Becker GJ, Meaney JA, et al. Anteromedial tibial tubercle transfer without bone graft. Am J Sports Med 1990;18:490‑497.

Figure 3.1. Patient‑drawn knee pain diagrams direct the examiner to areas of tenderness. Reprinted with permission from Post WR, Fulkerson JP. Knee pain diagrams. Correlation with physical exam findings in patients with anterior knee pain. Arthroscopy 1994; 10(6): 618‑623.

Figure 3.2. Evaluate the Q angle with the pa­tient standing.

Figure 3.3. Standing estimation of pelvic obliquity/leg length discrepancy.

Figure 3.4. Evaluate weightbearing hind­foot alignment.

Figure 3.5. Seated evaluation of tubercle sulcus angle. Markers are placed on center of patella and tibial tubercle for purpose of illustration only.

Figure 3.6. Patellar tilt test with knee extended. Tilt should correct to neutral.

Figure 3.7. A, Medial glide test, knee extended. B, Lateral glide (apprehension) test, knee extended.

Figure 3.8. A, Superior glide test, knee extended. B, Inferior glide test, knee extended.

Figure 3.9. Place soft tissues under tension before palpation. Reprinted with permission from Fulkerson JP. Awareness of the retinaculum in evaluating patellofemoral pain. Am J Sports Med 1982;10:147‑149.

Figure 3.10. Patient had saphenous nerve entrapment with hypesthesia as illustrated. Saphenous decompression relieved her pain. Reprinted with permission from Post WR, Surgical Decision Making in Patellar Pain and Instability. 1994;2(4):273‑284.

Figure 3.11. Perform direct articular compression at various angles of flexion. Be careful to avoid compressing the peripatellar soft tissues.

Figure 3.11. (continued) Articular compression at various angles of flexion helps to localize articular le­sions.

Figure 3.12. Evaluate hamstring tightness while the patient is supine.

Figure 3.13. Check for gastrocnemius tightness.

Figure 3.14. Evaluate for hip flexion contracture.

Figure 3.15. Test for quadriceps flexibility while the patient is prone.

Figure 3.16. Drawing demonstrating the lateral prominence of the greater trochanter and the measurement of femoral anteversion in the prone position. Reprinted with permission from Ruwe PA, Gage JR, Ozonoff MB, DeLuca PA. Clinical determination of femoral aversion. JBJS 1992;74A(6):821.

Figure 3.17. A, The contralateral hip is maximally flexed to eliminate lumbar lordosis. B, Flex the hip of the leg to be tested.

Figure 3.17. (continued) C, While the hip is flexed, abduct the hip maximally. D, Extend the hip while sta­bilizing the pelvis to keep it perpendicular to the examination table.

Figure 3.17. (continued) E, Allow the thigh to adduct while controlling femoral rotation in neutral. Note continued control of the pelvis with the examiner's left hand. F, At the position of maximal adduction, pal­pation over the distal iliotibial band often reproduces the patient s pain.

Figure 3.18. A, Lachman's test for excessive anterior tibial translation. B, Posterior drawer test: Palpate nor­mal position of tibia anterior to femoral condyle with the knee flexed 90 degrees

 


        

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