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- 您请求的操作仅限于组中的用户:主观检查主观检查对于确定PFPS的根本原因和影响因素至关重要。彻底的主观检查将使您的身体检查流程化,并制定适当的管理计划。询问有关症状行为和病史的具体问题将有助于您临床推断症状的原因和影响因素。识别导致PFPS的各种内在和外在因素将指导您的治疗计划。在个体中发现的因素越多,表明与较高程度的疼痛和功能损害相关Ferrari D, Briani RV, de Oliveira Silva D, Pazzinatto MF, Ferreira AS, Alves N, de Azevedo FM。[https://www.sciencedirect.com/science/article/pii/S0966636217307373?via%3Dihub较高的疼痛程度和较低的功能能力与髌股疼痛女性的运动学改变次数有关]。步态和姿势。。====病史====详细的病史将为您提供有关PFPS病因和影响因素的大量线索。Claire Robertson。膝关节主观检查课程幻灯片。 Plus2019Powers CM, Witvrouw E, Davis IS, Crossley KM. [https://bjsm.bmj.com/content/bjsports/51/24/1713.full.pdf Evidence-based framework for a pathomechanical model of patellofemoral pain:] 2017 patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester, UK: part 3. Br J Sports Med. 2017 Dec 1;51(24):1713-23 {| class="wikitable" |'''Subjective Finding''' |'''Possible Clinical Reasoning''' |- |Insidious Onset |Typical of PFPS |- |Overload event eg excessive stair climbing, longer distance |Typical of PFPS |- |Traumatic incident |Unlikely to be PFPS |} ==== Pain Behaviour ==== Anterior knee pain going up and down stairs, pain when sitting with knees flexed and pain with squatting, kneeling or returning from squat all implicate PFPS. The table below gives an overview of structures to examine depending on which subjective finding is identified {| class="wikitable" |'''Subjective Findings''' |'''Possible Clinical Reasoning''' |- |Pain when sitting with flexed knee (cinema sign) |Tight quadriceps (sitting they compresses PFJ) |- |Pain while sitting with legs crossed |Tight ITB (Glut max and TFL tightness) |- |Pain walking downhill |Loads PFJ |- |Pain walking uphill |Tight Calf muscles Impaired gluteal control |- |Pain when wearing high heels |Increases load on PFJ Increases distal instability |- |Pain when going downstairs |PF Joint surface problems Muscle length issues Eccentric quads function |- |Pain when going upstairs |Impaired gluteal control |- |Squat and kneel- Going down into squat In crouch position Coming up from squat | Eccentric quads Muscle length of quads Gluteal control |- |Pain with tight clothing as you flex your knee (eg skinny jeans) |Compressive forces- PFPS |- |Pain with tight clothing touching/ rubbing skin |Possibly more of a Chronic Pain picture with Sensitisation (Allodynia) |} ==== Patterns of Pain ==== {| class="wikitable" |'''Subjective Finding''' |'''Possible Clinical Reasoning''' |- |Pain only during activity |Think biomechanics |- |Pain only after activity especially much later or next day |Think inflammatory |- |Pain that improves with exercise |Think tendon/ muscle length |} ==== Clinical Signs ==== Cook et al suggest a positive diagnosis of patellofemoral pain syndrome whenCook, C., Hegedus, E., Hawkins, R., Scovell, F., & Wyland, D. (2010). ''Diagnostic Accuracy and Association to Disability of Clinical Test Findings Associated with Patellofemoral Pain Syndrome. Physiotherapy Canada, 62(1), 17–24.'' doi:10.3138/physio.62.1.17 : * Both pain on muscle contraction and pain on squatting are present * 2 out of 3 of the following are present - pain on muscle contraction and/or pain on squatting and/or pain on palpation * 3 out of 3 are present - pain on muscle contraction, pain on squatting and pain on kneeling