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Care of Musculoskeletal Problems in the Outpatient Setting - part 8

hội chứng có thể bao gồm yếu kém của người thắt đáy lưng hông, cơ bốn đầu tăng (Q) góc cao, cưỡi xương bánh chè, mất cân bằng giữa các vastus lateralis và VMO càng yếu, và lệch chi tiết của các cực thấp. Các góc Q được tính bằng cách vẽ một đường từ đỉnh chậu trước cấp trên thông qua điểm giữa của xương bánh chè. | 12. Knee Problems 247 syndrome may include weakness of the hip girdle increased quadriceps Q angle high-riding patella imbalance between the vastus lateralis and the weaker VMO and misalignment of the lower extremity. The Q angle is measured by drawing a line from the anterior superior iliac crest through the midpoint of the patella. Draw another line from the tibial tuberosity through the midpoint of the patella. The angle formed at the intersection of the two lines is the Q angle Figure 12.14 . Tibial tubercle Quadriceps muscle Anterior superior iliac spine Q-angle Midpoint of patella Figure 12.14. Drawing of the Q angle. Reproduced from Richmond J Shahady E eds. Sports Medicine for Primary Care. Cambridge MA Blackwell Science 1996 398 with permission. 248 J.R. Gravlee and E.J. Shahady 8.3. Imaging Imaging is only needed to rule out other entities. The PFPS diagnosis is clinical. 8.4. Treatment of Patellar Femoral Pain Syndrome Quadriceps strengthening especially the VMO is the cornerstone of treatment to help improve the tracking of the patella. Quadriceps exercises are described at the end of the chapter. Exercise 3 straight leg raising is very helpful for PFPS. Ice nonsteroidal anti-inflammatory drugs NSAIDs and arch supports to correct ankle pronation are also suggested interventions. Patella bracing and bands are commonly used with varying effectiveness. The great majority of the time conservative measures are effective. Surgery is a rare option for resistance cases. 8.5. Iliotibial Band Syndrome Iliotibial band syndrome ITBS is another common overuse syndrome associated with running and other knee flexion activities such as cycling skiing or weightlifting. It is the most common overuse syndrome in distance runners and the most common cause of lateral knee pain. It is more common in men than in women. Iliotibial band syndrome is caused by faulty training techniques running on hilly terrain and anatomic malalignment. The usual presentation is a sharp burning