Lateral and anterior knee pain Flashcards
(55 cards)
What is the standard structural explanation for lateral knee pain?
- caused by inflammation at the distal ITB as it crosses over the lateral condyle
- ITB friction syndrome
What structures does the ITB connect to?
- TFL and glute max/med proximally
- proximal anterior tibia and patella distally
T or F;
You can see movement of the ITB with contraction of the TFL and glutes at the same time.
- F
- ITB is really just a passive stabilizer, it doesn’t move with muscular contraction
When the knee is flexed, the ITB is _________ to the lateral femoral condyle
- posterior
When the knee is extended, the ITB is ________ to the lateral femoral condyle
- anterior
The ITB is a relative passive ______ when the knee is in flexion, and a relative passive ______ when the knee is in extension.
- knee flexor when in flexion
- knee extensor when in extension
Would you characterize the attachment of the ITB to the patella as minor or major?
- minor
Lateral knee pain is common with which athletic activities?
- running and cycling.
- Also likely quick walking
T or F;
Lateral knee pain is the most common running injury with an incidence up to 12%
- T
The ITB alternates between extensor and flexor of the knee at ~____* flexion
- ~20*
T or F;
Friction is the cause for ITB distal irritation.
- debatable. Some say friction, others say just repetitive loading.
What are some primary structural sources of lateral knee pain? (5)
ITBFS, lateral meniscal injury, LCL injury, popliteal tendinopathy, proximal dib fib joint dysfunction
What are some primary structural sources of medial knee pain? (3)
Pes anserine bursitis, MCL injury, medial meniscal injury
What are some primary structural sources of posterior knee pain? (2)
Baker’s cyst, popliteal tendinopathy
What standard test can be done to assess for ITB involvement in lateral knee pain?
- Ober’s. Not the greatest, and won’t tell you that much in the way of specificity, but can give some useful information if there is a marked asymmetry
What provocative test can be done to test for ITB involvement in lateral knee pain?
- compress the distal ITB and flex/extend the knee repeatedly ~20* of flx; in side lying
What knee position should Ober’s be done in?
- ~90* flexion and in extension to assess loading as both a passive extensor and a passive flexor
When is imaging appropriate for atraumatic lateral knee pain?
- really not until conservative management fails
In general what is a guideline for when knee imaging is appropriate or not? (ACR recommendation not Ottawa)
(5)
- no fall
- no twisting injury
- no focal tenderness
- no effusion
- can walk
T or F;
There is strong evidence to support guidelines for conservative management of lateral knee pain
- F
- nope
In general, what are the recommendations for treating lateral knee pain, conservatively? (6)
- manage inflammation in acute phase
- stretch ITB and related structures
- strengthen hip abductors
- promote strength/control of hip abductors
- STM to appropriate soft tissue (deep tissue massage to ITB)
- rest and activity modification
What regions are appropriate for joint mobilization for lateral knee pain? (2)
- PF joint (lateral retinaculum)
- proximal tib-fib joint
What are thought to be the three primary mechanicsms/contributors to anterior knee pain?
- malalignment/tracking of the patella
- chondromalacia patella (softening of the patellar cartilage)
- poor motor control of quads and hip abductors
The patella is least stable in which position?
- full extension
