Welcome to Medical Terms
Secretary's knee:
The patellofemoral syndrome( PFS ) , the commonest cause of
chronic knee pain. PFS characteristically causes vague
discomfort of the
inner
knee area, aggravated by activity ( running, jumping,
climbing or descending
stairs ) or by prolonged sitting with knees in a moderately
bent position
( the
so-called "theater sign" of pain upon arising from a desk
or theater seat ) .
The knee may be mildly swollen. If chronic symptoms are
ignored, the loss of
quadriceps strength may cause the leg to "give out."
PFS is
caused by an
abnormality in how the kneecap ( patella ) slides over the
lower end of the
thigh bone ( the femur ) . Normally, the patella ( kneecap ) is
pulled up over
the
end of the femur in a straight line by the quadriceps
( thigh ) muscle. In PFS
there is patellar "tracking" toward the lateral ( outer )
side of the femur.
This off-kilter path permits the underside of the patella
to grate along the
femur leading to chronic inflammation and pain. Females are
at greater risk
than males for PFS. Knock-kneed and flat-footed runners and
persons with an
unusually shaped patella are predisposed to PFS.
Initial
pain management is
icing, anti-inflammatory drugs ( Advil/Motrin; Aleve ) and
avoiding motions
which irritate the kneecap. Treatment and rehabilitation
are designed to
create a straighter pathway for the patella to follow
during quadriceps
contraction. Selective strengthening of the inner portion
of the quadriceps
muscle helps normalize the tracking of the patella.
Cardiovascular
conditioning can be maintained by stationary bicycling ( low
resistance but
high rpms ) , pool running, or swimming ( flutter kick ) .
Changes in training
that
may have led to the PFS pain should be reviewed and running
shoes examined
for
proper biomechanical fit to avoid repeating the painful PFS
cycle.
Occasionally bracing with patellar centering devices is
required.
Stretching
and strengthening the quadriceps and hamstring muscle
groups are essential
to
an effective and lasting rehabilitation of PFS. "Quad
sets" are the
foundation for such a program and are done by contracting
the thigh muscles
while the legs are straight and holding the contraction for
a count of ten.
Sets of 10 contractions are done between 15-20 times per
day. Under optimal
circumstances, there should be a rapid recovery and return
at full
functional
level to sports.
PFS has also been called "housemaid's
knee" and "chondromalacia patella."