Patellofemoral pain - course

Dr Ronald Grelsamer is an associate clinical professor at the Mount Sinai Hospital in New York.

He has decades of experience in managing problems of the knee related to the patella. In this course he gives a comprehensive overview of those conditions that can cause pain in the patellar region.


Page first published 2008, and reviewed August 2023 by Dr Sheila Strover (Clinical Editor)

 

This glossary accompanies my course on patellofemoral pain. If you can slowly build up your vocabulary you will be able to read internet articles with greater understanding.

 

abrasion arthroplasty - burring down the joint cartilage

ACI - two-stage operation to replace damaged cartilage with cells grown in a laboratory

allodynia - pain from a stimulus that is not normally painful

anterior knee pain syndrome - a 'catch all' term which simply means you have pain at the front of the knee. It is not a diagnosis

apprehension sign - in patients who have previously dislocated their patella, any attempt by the surgeon to test its laxity will be vigorously resisted as the patient is apprehensive

AP view - x-ray or other imaging technique from the front

arthrofibrosis (of patella) - scarring under the patellar tendon with pain and stiffness

articular cartilage - the smooth white gristle covering the part of a bone where it forms a joint with another bone

atrophy - wasting

back knee'd - when the knees go beyond straight and bend backwards when standing

Baker's cyst - a fluid-filled lump at the back of the knee

benign - not cancerous

bi-partite patella - a patella which has developed imperfectly, leaving a section unfused to the main body, and which can resemble a fracture

bone scan - test for over active bone

bow-legged - the knees bow out - so that there is a space between the knees even when the feet are together

Blumensaat's line - a line drawn on an x-ray to show whether the knee cap is too low or too high

bowstring - imagine a soap (the knee cap) with a long rope (quads) going through it. The bottom bit of 'rope' is pulled to the outer side by virtue of being attached to the tibial tubercle (making the Q angle). The 'soap', however, is held back by the walls of the groove in which it lies. So when the leg is straightened and this 'rope' taughtens, the forces on the 'soap' increase.

bowstringing - see bowstring

bursa - a kind of flat pocket lubricating awkward body areas to protect tendons from rubbing too hard

capsule - soft envelope surrounding a joint.

catching - a brief episode when sudden pain stops the knee from moving normally

chondroitin sulfate - nutritional supplement

chondromalacia - outdated term with multiple meanings. Can mean abnormally soft cartilage, cartilage ulcers, or pain at the front of the knee. It is not a diagnosis (see anterior knee pain syndrome, patellofemoral syndrome)

complex regional pain syndrome - a pain disorder, where the pain response is out of proportion to the underlying problem. The skin can be cold, hot, sensitive to touch, and /or blotchy.

complex torsional variations - various combinations of twisting of the femur and tibia

condyles - the two rounded 'knuckles' at the lower end of the femur

congenital - something you are born with

constitutional laxity - 'double' joints

crepitus - crackly noise (or sensation) in the joint

CRPS - see complex regional pain syndrome

CT - computerized tomography. A technique of imaging

diagnosis - what is causing the medical problem

dislocate/dislocated - when the knee cap is no longer contained by the sides of the trochlea, and rides outside of it

distal realignment - moving the tibial tubercle

dorsal defect - localized bone disorder that gives the appearance of a 'hole in the bone' on x-ray

dystrophy - abnormal development

effusion - excessive joint fluid

Ehlers-Danlos syndrome - a specific group of symptoms associated with severe double-jointedness (hypermobility)

Elmslie-Trillat - a type of tibial tuberosity transfer

excessive lateral pressure syndrome - when the knee cap is tilted, with more pressure on the tilted side, causing pain

examination - examination (hands on)

extend - straighten (the leg)

extension - straightening (the leg)

extensor mechanism - the quadriceps muscle and its bony attachment to hip and femur, quadriceps tendon, knee cap, patellar tendon, and tibial tubercle

facets - the flattened surfaces on the underside of the knee cap

faradism - a mode of electrical therapy for rehab

fat pad - the lump of fat normally found under and to the sides of the knee cap

fat pad syndrome - nipping of a large fat pad in the joint, causing pain and scarring of the fat pad

femoral epicondyle - bony knob on the femur on the outer side of the knee

femur - thighbone

femoral epicondyle - the little bony lump on the side of the knee

fibrocartilage - inferior cartilage produced by damaged joints in an attempt to heal

fibula - the thinner bone on the outside of the tibia

flexes - bends

flexion - bending (the knee)

focal lesion - a discrete problem area

fracture - a bone break

Fulkerson - a type of tibial tuberosity transfer

gait analysis - objective measurement of the pattern of gait and the forces exerted

glucosamine - a nutritional supplement

gout - a painful chemical disorder of the body where uric acid crystals can be deposited in the knee and other joints

grasshopper knee caps - when the knee caps point outwards

haemarthrosis - bleeding into the joint

hams - same as hamstrings

hamstrings - the muscle group at the back of the thigh

history - the patient's story

hyperactive - over active

hypermobility syndromes - conditions with 'double' joints as a feature

ilio-tibial band - a long fibrous band running down the length of the outer thigh

infra-patellar bursitis - inflammation and tense fluid in the bursa (lubrication sac) under the knee cap

imaging - techniques of demonstrating bones or soft tissues, x-rays, MRI, CT, bone scan

immunocompromized - depressed immune system

instability (of the knee cap) - when the knee cap is not properly contained in the trochlear groove throughout its excursion

interferential - a mode of electrical therapy for rehab

ITB - same as ilio-tibial band

J sign - in some abnormal knees, as the knee moves into extension (straight), the patella moves up and out - like a 'J'

joint line - the circumferential line around the knee representing the bony contact between femur and tibia

knock knees - when the knees are touching the feet are wide apart

lateral - a 'position' word meaning 'towards the outer aspect'

lateral displacement - too far over to the outer aspect

lateral facet - the flattened undersurface of the patella, on the outer or lateral side

lateral retinaculum - fibrous support on the outer aspect of the knee cap

lateral retinacular release - a surgical procedure to cut the lateral retinaculum

lateral view - x-ray or other imaging technique from the side

leg curl - muscle strengthening exercise

press - muscle strengthening exercise

ligament - the fibrous material connecting bone to bone

malalignment - abnormal alignment of one or more structures of the extensor mechanism, causing abnormal stresses on the patella

malignant - cancerous

maltracking - abnormal patellar excursion in the trochlea

Maquet - a type of tibial tuberosity transfer

medial - a 'position' word meaning 'towards the inner aspect'

medial reefing - taking a 'tuck' in the medial retinaculum

medial retinaculum - fibrous support on the inner aspect of the knee cap

meniscus - the shock absorber between femur and tibia

Merchant view - a special x-ray view

metabolic rate - the rate of cellular activity

microfracture - 'picking' the joint cartilage to encourage formation of fibrocartilage

miserable mal-alignment - inwardly rotated patellae ('squinting'), due to rotational deformity of femur and tibia

myofascial trigger point - same as trigger point

neuroma - when a nerve gets itself tangled up into a painful lump

neoplasm - same as tumor

nuclear imaging - a form of imaging using radioactive material

OATS - replacing damaged joint cartilage with little plugs of normal cartilage

Ober test - a test for a tight ilio-tibial band

OCD - same as osteochondritis dissecans

orthotics - shoe inserts

orthotist - person qualified professionally to fit orthotics

Osgood Schlatter's condition - painful enlargement of the tibial tubercle in children

osteochondritis dissecans - in this disorder, a focal area of joint surface is strangled of its blood supply and dies, leaving a crater

osteoporosis - thinning of bone

osteomyelitis - infection of bone

osteotomy - a surgical procedure where bones are cut and moved into a different angle or shape

palpate - feel with the hands and fingers

patella - the knee cap

patella alta - a patella which is positioned too high up on the femur

patella infera - same as patella baja

patellar arthrofibrosis - scarring under the patellar tendon with pain and stiffness

patella baja - a patella which is positioned too far down, usually the result of shortening of the patellar tendon

patellae - the plural of patella

patellar dysplasia - abnormal development of the knee cap so it ends up too big, too small or a funny shape

patellar tendon - the fibrous portion of the quadriceps muscle just below the knee cap

patellar tendinitis - degenerative condition of the patellar tendon. Also called tendinopathy or tendinosis.

patellar tendinopathy - degenerative condition of the patellar tendon. Also called tendinitis or tendinosis.

patellar tendinosis - degenerative condition of the patellar tendon. Also called tendinitis or tendinopathy.

patellar tilt - listing of the patella to one side

patellectomy - operation to cut out the patella

patello-femoral joint - the bony contact between patella and femur

patello-femoral replacement - replacing patellofemoral joint with artificial components

patello-femoral resurfacing - replacing patellofemoral joint with artificial components

patello-femoral syndrome - a non-specific term for pain originating in the patello-femoral joint

pathology - disorder

peri-patellar pain - pain around the knee cap

pes anserine tendons - attached on the tibia, on the inner aspect just below the knee joint line

plica - a plica (eg medial plica, supra-patellar plica) is a fold of joint lining, which may be present inside the knee from birth.

plica syndrome - a plica is a fold of joint lining, which may be present inside the knee from birth. A plica syndrome is a group of symptoms - pain and tenderness around the knee cap, crackling sounds in the joint, a 'catching' sensation in the knee.

popping - a noise (and sensation) in the knee

pre-patellar bursa - the lubrication sac over the knee cap

pre-patellar bursitis - inflammation and tense fluid in the bursa (lubrication sac) over the knee cap

pronate/pronation (the foot) - when the foot rolls inwards

proximal realignment - realigning the extensor mechanism from above the tibial tubercle

pseudo-locking - 'false' locking. The knee locks up momentarily.

Q angle - the angle that the femur and quadriceps muscles makes with a line drawn from the tibial tubercle to the middle of the patella

quadriceps muscle - the 'lap' muscles - made up of four parts

quads - same as quadriceps muscles

quads sets - muscle strengthening exercise

quadriceps tendon - the fibrous portion of the quadriceps muscle just above the knee cap

quadriceps tendinitis - degenerative condition of the quadriceps tendon. Also called tendinopathy or tendinosis.

quadriceps tendinopathy - degenerative condition of the quadriceps tendon. Also called tendinitis or tendinosis.

quadriceps tendinosis - degenerative condition of the quadriceps tendon. Also called tendinitis or tendinopathy.

rectus femoris - one of the four muscles making up the quadriceps muscle

referred pain - pain originating away from the area in which it is experienced

reflex - beyond the control of the patient

reflex sympathetic dystrophy - same as complex regional pain syndrome

rheumatoid arthritis - a condition in which arthritis affects multiple joints, often including the knuckles of the hands, and leads to deformed joints

rheumatological conditions - a group of medical disorders where arthritis of multiple joints is accompanied by other medical symptoms - unwellness, eye problems etcetera

Rosenberg view - a special x-ray view

rotational deviation of tibial tubercle - the tibial tubercle is in the right place, but rotation of the tibia has moved it too far over to the side

Roux - a type of tibial tuberosity transfer

RSD - same as reflex sympathetic dystrophy

Schuss view - a special x-ray view

sensory nerve - nerve which relays sensations including pain

short arc extensions - muscle strengthening exercise

Sinding-Larsen-Johansson syndrome - painful just on the lower bony edge of the kneecap

slipped capital epiphysis - a hip condition of children and adolescents, whuch can lead to arthritis

snapping - a noise (and sensation) in the knee

squinting - see squinting patellae

sprain - partial tear of muscle or tendon

squinting patellae - when the kneecaps face inwards towards each other, like squinting eyes

standing AP view - a special x-ray view

standing flexion view - a special x-ray view

standing tunnel AP view - a special x-ray view

step ups - muscle strengthening exercise

stress fracture - repeated stress to a bone can undermine its integrity and produce a break

subluxation - when the knee cap slips up the wall of the trochlea, but does not actually dislocate

supra-patellar pouch - extension of the joint cavity into a flattened pouch above the knee cap

sympathetic - a part of the nerve structure in the spine

sympathetic block - anaesthetising the sympathetic nerves

symptomatically - symptom by symptom, ie each symptom treated individually

synovial impingement - nipping of excessive joint lining between the bones

synovitis - inflammation of the synovium

synovium - the delicate lining of the joint

Synvisc - injectable joint lubricant

technetium - a radioactive material used in bone scans

tendon - the fibrous material connecting a muscle to bone

tendinitis - also called tendinosis or tendinopathy. A degenerative condition affecting a tendon.

TENS - transcutaneous electrical nerve stimulation - a mode of electrical pain relief

Theraband - heavy duty elastic band for resistance rehab

tibia - the shin bone

tibial rotation - a twist in the long axis of the tibia

tibial tubercle - the bony lump a thumbsbreadth below to kneecap, to which the patellar tendon attaches

tibial tuberosity - same as tibial tubercle

tibio-femoral joint - the bony contact between femur and tibia

tilt - same as patellar tilt

translational deviation of tibial tubercle - the tibial tubercle is too far to one side, although the tibia is not rotated

traumatic fracture - classic bone break from sudden injury

trigger point - area of muscle tenderness which triggers pain elsewhere

trochlea - the groove in the femur bone along which the knee cap slides

trochlear dysplasia - abnormal trochlear groove, where the walls are imperfectly developed

trochlear groove - same as trochlea

tumor - a growth. Same as neoplasm

ultrasound - a mode of electrical therapy for rehab

unstable (knee cap) - the groove in the femur bone along which the knee cap slides

unsymptomatic - not causing any symptoms

valgus deformity - knock knees

varus deformity - bow legs

vastus intermedius - one of the four muscles making up the quadriceps muscle

vastus lateralis - one of the four muscles making up the quadriceps muscle

vastus medialis - one of the four muscles making up the quadriceps muscle

vastus medialis obliquus - lower fibers of the vastus medialis. They are less vertical than the remainder of the vastus medialis and help the patella from slipping laterally when the quad muscles contract.

VMO - same as vastus medialis obliquus

 


PREVIOUS PART: Surgery to slow established patellofemoral arthritis

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