近日複習去年12月底至台中榮總參加的2022國際膝關節疾病與治療高峰會，又再有一些體會，筆記整理之。
Current trends in management of
PFP syndrome
dysfunction in the mechanical force between patella and femur=>patella maltracking, alignment, soft tissue imbalance
vastus medius=VMo+VML
Scenario: 可能看一場電影看一場戲後就痛起來了
Clinical symptoms:anterior knee pain
做Terminal knee extension exercise
flexion角度不要太大
另外要留心:
femur anteversion會增加valgus角度foot pronation角度
都會造成patella往外拉的分力
後來研究指出單獨訓練VMO效益不佳
=>走往role of hip muscle, add hip IR and add enhance VMO activation,但效益也不佳
=>再走向增加hip abductor and ER strengthening, 和增加proximal stability
=>似乎效益較佳(?)
訓練:
open vs closed kinetic chain exercise
open chain時 能訓練到單一肌力 能訓練到最大肌力
close chain 沒辦法訓練到最大肌力 比較functional
比較能轉嫁到功能 比較能同時訓練anta/agonist 加強本體感覺
單腳蹲時 G.medius很重要
甚至可搭配電刺激訓練electrical stimulation: single patterned electrical stimulation, agonist and antagonist, knee bracing + insoles , kinesio tapping+McConnell taping也可同時操作!
hip muscle strengthening
stretching exercise...propioceptive neuromuscular facilitation
postural stabilization exercise........transverse abdominis, multifidus co contraction, anterior pelvic tilt, femoral internal rotation and adduction
Q angle正常時 可以focus on knee,但若Q angle不正常 , 要上下找一找
hamstring太緊，也會影響foot pronation,往上又代償到Q angle擴大
Current Trends in Management of Fat Pad Syndrome
Current trend in the management of infrapatellar fat pad syndrome
anterior knee pain不要忘記fat pad syndrome
可做Hoffa massage,避免夾擊
思路: 我們要把fat pad當成是一個會引起問題的組織,而不是只在保護我們
注意此條神經:
**Infrapatellar branch of saphenous nerve
fat pad 的pressure在極端角度時最大，因為為了保護關節
其實fat pad有和proximal patellar tendon相連,也連到deep quadriceps tendon(?)
PFPS 也可當fat pad syndrome處理=>要避免hyperextension
infrapatellar plica(ligamentum mucosum)也會連到fatpad
可做Hoffa test
**scissor action** when flexing under load =>不只extension痛,flexion蹲也會痛
關節鏡後fat pad可能會造成anterior interval的scarring
治療策略:
Quadriceps training without knee hyperextension
Pelvic control:training of G.medius and stretching the anterior hip may decrease IR of the hip and valgus firce of the knee
Gait training and avoiding hyperextension can also be used
+靠貼紮讓Patella bone不要壓迫fat pad太多
Wall or door Jam:關鍵是讓heel往下壓
Gluteus training: wall lean
Modified gluteus training to avoid hyperextension: life stance
Nerve mobilization: saphenous nerve
**深蹲末端可能對有fat pad的病人有極大壓力,對正常人沒關係,對OA也沒那麼適合
insole? 可用可不用=>要先評估腳的instability
