Lecture on Differential Diagnosis and PFPS

Introduction

• Begin with individual practice on differential diagnosis, followed by group discussion.
• Focus on differentiating specific knee injuries, not general statements like 'knee pain.'
• Importance of identifying unique characteristics of each injury.

Differential Diagnosis Practice

• Process:
  • Start with individual analysis of given injuries.
  • Exchange papers with others and discuss findings.
• Key Injuries:
  • MCL (Medial Collateral Ligament)
  • Meniscus
  • PFPS (Patellofemoral Pain Syndrome)

MCL and Meniscus

• MCL:
  • Special Test: Stress test at 30 degrees.
  • Symptoms: Pain, instability, swelling, possible pop or snap at injury.
• Meniscus:
  • Special Tests: McMurray's, joint line tenderness, catching/locking.
  • Symptoms: Swelling, pain with compression or flexion.

PFPS vs. IT Band Syndrome

• PFPS (Patellofemoral Pain Syndrome):
  • Symptoms: Anterior knee pain, grind test positive, pain with sitting.
  • Observations: Maltracking of the patella (J-sign).
• IT Band Syndrome:
  • Symptoms: Lateral knee or hip pain, positive Ober's test.
  • Observations: Snapping over the lateral epicondyle.

Tendinopathy vs. Stress Fracture

• Tendinopathy:
  • Symptoms: Pain localized to the tendon, weakness.
  • Tests: Elicited through movement and tenderness.
• Stress Fracture:
  • Symptoms: Bone pain, night pain, positive tuning fork test.
  • Diagnostics: May not show on X-ray immediately; visible as healing progresses.

Patellofemoral Pain Syndrome (PFPS)

• Overview:
  • Common in athletes, often difficult to pinpoint pain.
  • Involves pain at the joint between the patella and femur.
• Types:
  • Compression (overuse leading to inflammation).
  • Maltracking (patellar shifts, often laterally).
• Diagnosis and Treatment:
  • Functional tests: Squats, step-downs.
  • Treatment: Modify activity, strengthen glutes and quads, focus on hip and trunk control.
  • Short-term: Orthotics and taping to manage symptoms.

Key Points

• Importance of monitoring dynamic movement to understand issues like dynamic valgus.
• Surgical interventions are rare and only after exhaustive rehab efforts.
• Treatment focuses on correcting movement patterns rather than isolated symptoms.

Conclusion

• Reinforcement of understanding differential diagnosis as a crucial skill.
• Emphasis on application of knowledge in clinical settings.