This is a draft cheat sheet. It is a work in progress and is not finished yet.
PAB
- Sartorius, gracilis and semitendinosus tendons
- Knee flexors and tibial internal rotation - helps protect knee from rotary and valgus stress, contracts eccentrically during terminal knee ext to stop excess ext rot
- Bursa reduces frictions between tendons and tibia
- Stresses trigger synovial linging to produce excessive fluid - painful inflammation
Risk Factors
- Obesity |
- Knee OA |
- Diabetes |
- Female gender (wider pelvic and increased Q angle) |
- Runners, breaststroke swimers, athletes - cutting/side to side movement |
- Hamstring tightness |
- Lack of knee extension |
- Improper/rapid changes in training |
- Can co-exist with other knee disorders - Osgood schlatter, plica irritation, meniscus injury, degeneration |
- Pes planus/valgus knee |
Presentation
- Difficult to localise pain for patient |
- Mild-Moderate pain over medial tibia near insertion of conjoined tendons , 5cm below medial joint line of the knee and 3-4 cm medial to TT |
- Aggravted by descending stairs or arising from seated position + side to side movement |
- ROM - pain during knee flexion, RROM knee int rot /knee flex |
- Swelling can occur |
- Assess hamstring flexibility, hip abductor weakness, pes planus - increase valgus stress of the knee |
Imaging
- Not requited unless bony pathology |
- US/MRI usually considered |
DDx
- Meniscus injury |
- Ligamentous sprain |
- Tendinopathy |
- Neoplasm |
- Tibial stress f# |
- Inflammatory Arthropathy |
- Osteochondritis dissecans |
- Lx radiculopathy |
- Plica irritation |
- Osteonecrosis |
- OA |
Management
- Ice , US, e-stim, NSAIDs |
- Myofascial release and stretching of sartorius, gracilis, semitendinosus |
- SMT of LS + LL |
- Arch supports |
- Stretching of hamstring, adductors, quads, gastro |
- Strengthening of hip abductors |
- Overweight pts - diet and exercise |
- If non responsive consider injection and later on surgical intervention |
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