Discharge Instructions - Patellofemoral Pain Syndrome

As discussed in the Emergency Department prior to discharge, based on our evaluation your pain is most likely due to patellofemoral pain syndrome.  Patellofemoral pain is a condition that causes pain in the front of the knee. It involves the knee cap, which doctors call the "patella."  Many times, patellofemoral pain happens in runners or other people who put a lot of pressure on their knees.  But the condition can also happen when a person's knee cap gets out of line with the knee joint.

Patellofemoral pain causes pain in the front of the knee, or around or behind the knee cap.  The pain can come on slowly or quickly.  The pain is usually worse when people squat, run, or sit for a long time.  Some people might also feel as if their knee is giving out.

Treatment usually involves a few parts.  The first part of treatment helps to reduce your pain. It can include:

-Resting your knee and avoiding activities or movements that make the pain worse.

-Taking nonsteroidal antiinflammatory drugs, also called "NSAIDs."  NSAIDs are a large group of medicines that includes Ibuprofen (sample brand names: Advil, Motrin) and Naproxen (sample brand names: Aleve, Naprosyn).

-Putting ice on your knee when it hurts or after activities that cause pain.  You can put a cold gel pack, bag of ice, or bag of frozen vegetables on the painful area every 1 to 2 hours, for 15 minutes each time.  Put a thin towel between the ice (or other cold object) and your skin.

Another part of treatment involves doing exercises to strengthen the muscles around your knee.  Your doctor or nurse will show you which exercises to do, or he or she will have you work with a physical therapist (exercise expert).

Your doctor might also recommend that you:

  -Wear a knee brace to support your knee.

  -Tape up your knee in a certain way to support your knee.

  -Wear special shoe inserts made to fit your foot (to keep your foot from turning in or out too much).

It is important that you follow up with your primary care provider to arrange for additional treatment options, including referral to physical therapy.

Your symptoms will most likely improve with treatment. But if they don't, your doctor might have you see a knee specialist to discuss treating your condition with surgery.

https://orthoinfo.org/en/diseases--conditions/patellofemoral-pain-syndrome/

https://mydoctor.kaiserpermanente.org/ncal/Images/patellofemoral_tips_exercises_tcm75-823272.pdf

https://thrive.kaiserpermanente.org/care-near-you/northern-california/santarosa/wp-content/uploads/sites/15/2015/09/Patellofemoral-Pain-Syndrome_tcm28-180773.pdf

MDM - Patellofemoral Syndrome

[##]-year-old [male/female] with [right/left] knee pain with history and exam consistent with likely patellofemoral pain syndrome (“runner’s knee”).

Initial consideration in this patient included knee dislocation, patellar and other knee fractures, patellar and quadriceps tendon injury or rupture, meniscus and ligamentous knee injuries, arthritis, Osgood-Schlatter disease, pes anserine and prepatellar bursitis, and septic arthritis amongst others.

Patient presented with report of gradual onset of unilateral, anterior, non-radiating knee pain that is reportedly worsened by prolonged knee flexion (“moviegoer syndrome”) and stair climbing.  Patient noted to have a positive patellar grind test of the [right/left] knee (press patella away from femoral condyles while patient contracts the quadriceps; sudden patellar pain and relaxation of the muscle is a positive test).  Plain films were considered [unnecessary in patient without significant history of trauma, bony tenderness or deformity, or other findings suggestive of dislocation, fracture or other significant injury/and obtained with no evidence of significant abnormality/obtained and notable for a patella that does not line up with the groove of the femur on sunrise view/decreased space posterior to patella/bony erosions].

Prior to discharge, we discussed return precautions, symptomatic treatment with rest, ice, compression, and exercises as described in the handout provided at time of discharge, and follow up with primary care doctor within one week for further evaluation and consideration of referral to physical therapy, and the patient demonstrated understanding and agreement.

https://orthoinfo.org/en/diseases--conditions/patellofemoral-pain-syndrome/

https://mydoctor.kaiserpermanente.org/ncal/Images/patellofemoral_tips_exercises_tcm75-823272.pdf

https://thrive.kaiserpermanente.org/care-near-you/northern-california/santarosa/wp-content/uploads/sites/15/2015/09/Patellofemoral-Pain-Syndrome_tcm28-180773.pdf