Hello. I'm Brett DeGoyer. I'm a primary care sports medicine specialist working for Samaritan Healthcare in Moses Lake, Washington. So looking at an athlete or a patient who's coming in with patellofemoral complaints, what I like to do is, of course, palpate the patella, looking at the medial margin right here and the lateral margin here, inferior and superior margins. I like to grasp above and below and then move the patella in the different quadrants to look for laxity. While I'm doing that, I'll also add some pressure to induce that lateral motion so I can palpate underneath the patella along the lateral patellar facet. And then I'll switch and push along the lateral margin so I can palpate up underneath along the medial patellar facet, looking for pain and sensitivity, which can indicate that there's an issue in the patellofemoral joint. From this position, I'll grasp again, and adding compression posteriorly into that trochlear groove, I'll grind the patella, superior and inferior, lateral and medial, to look for crepidence and pain. Again, that's an indication that there's some chondromalacia patella that's there. And if there's any amount of apprehension, then there might be some instability. Now, from there, we can actually do an apprehension test, pushing the patella out lateral. And if that induces pain or a sense of anxiety on part of the patient, that's a positive test. And you can induce that the opposite direction to see if there's any medial instability. If there's no pain, one of the things that I like to do in my testing is to go ahead, induce that lateral motion, and then I'll have the patient gently start to bend or flex their knee. If that induces pain or a feeling of anxiety, okay, that's a positive apprehension test. If I do the opposite, inducing a medial motion and have the patient gently bend or flex their knee, and that reduces the pain or takes it away completely, that just substantiates that there's some instability there, especially laterally. That's causing some sense of pain and feeling of instability. Another test to do is the Clark's test. And that's inducing pressure along that superior margin of the patella using the webbing between your thumb and your index finger. As I'm compressing posterior and inferior, I'll ask the patient to gently contract their thigh muscles or their quadriceps. If that induces a lot of pain, that's a positive test, again, indicating that there's an issue in the patellofemoral joint. For more information, visit www.FEMA.gov

2nd Edition, CASE 25

2nd Edition

Knee

patellofemoral complaints

patella apprehension test

chondromalacia

Clark's test

patellofemoral instability