Fat pad impingement

[jenniferlam]

Hi there, I have just joined this forum, really finding it helpful, good stuffkeep it up.

I am currently treating a patient with anterior knee pain for half a year now, she compliants of anterior knee pain when forcefully straighten knee and that limits her from walking fast and prolong walking. after examination, her signs and symptoms turned out to be a fat pad problem.

What is the management for this condition and what type of exercise should I start her off with?

Thanks

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[thephysiosvoice]

As long as there is no patella (AP) issue and it is purely an extension over squeeze issue, then tape it a la McConnell which MUST decrease the pain (or no point putting on tape!) and get the patient to understand and control function, weightbearing inner range quads stuff.

Crack on for 3 weeks or so and you should see a change in symptoms.

Cheers

TPV

[linbin]

hi all
since its felt as a fat pad syndrome,the line of management will be a bit different.as all know,fad pad syndrome has an indirect association with the menstural cycle.history regarding it becomes relevant.
the pain and associated symptoms arises when effusion in the infrapatellar region lift the fat pad up due to the density difference.this come into contact with the highly innervated and sensitive synovial membrane.
so to relieve the symptoms there should be minimising of contact between the fat pad and synovial membrane.
so the treatment plan include
taping technique
management directed to reduce effusion
activity modification
avoiding of position which causes excess contact of fat pad with synovium

[physiobs]

If it is a true Hoffa's impingement and 6 months of treatment hasn't helped one must question whether arthroscopy might be needed to excise the impinging part of the alar fold ( I've been in theatre during a fat pad trim and the fat has transformed at the impingement site to a dense, fibrous, almost meniscoid appearance). Otherwise, clearly IRQ exercises for VMO should be avoided and maybe core stabilising exrcises should be shown with the knee in about 10 degrees of flexion. Also a heel raise might help as it reduces WB hyperextension when walking. It is unlikely that a medial patellar shift due to McConnell taping will have any effect on a londitudinal compression.

[ginger]

instead of a "diagnosis " for fat pad anything, just read, another medical euphemism for " I don't know , but why not put you into this labelled box as I have no idea what to do with you "
Continuous mobs to L3 will almost certainly eliminate these knee pain events, referred from the mid lumbar spine. Some attention to a tight femoral nerve may be needed , but a long winded series of Rx's to the knee will, like as not , just go nowhere.

[alzantello]

Hello, I am an employee at a physical therapy clinic and I graduated with a BS in Kinesiology. I am an avid competitive volleyball player who dealt with fat pad impingement. I dealt with it for over 9 months before I got any relief. In the end it was arthroscopic removal of the fat pad which granted me about 90% relief from the problems I was having.

I tried a month if physical therapy, was taking various NSAIDS almost around the clock, limited my activities for a period of time, tried cortisone injections, ice, McConnell taping you name it. Nothing gave me more than about 20% relief for a very short period of time.

The orthopedic surgeon, PA, and physical therapist all thought it was simple chondromalacia at first. My main complaints were pain at rest (in both extension and flexion), pain with stairs, extreme pain with terminal knee extension, difficulty transferring from my car, pain with jumping and landing, and difficulty sleeping at night due to the pain waking me up. It even bothered me when walking at times. I was never inhibited from playing volleyball; I would just grit my teeth and play the game I loved.

That being said, the arthroscopy was incredibly successful for me. I had almost immediate relief of the pain at rest and with rehab after the arthroscopic surgery I was back to playing sports within about 3 1/2 weeks. I experienced some similar pain due to some significant scar tissue but that resolved as the scar tissue broke up a little. I still have minimal problems with the anterior knee pain but overall I am very pleased with the outcome.

Some things to note:
I have several predispositions to fat pad impingement including patella alta, genu recurvatum, and some patellar instability.
The main thing that separated my case from general chondromalacia was that I had pain with extension and had full flexion.
I tried conservative measures first but they didn't offer me any significant relief.

I hope this can be of assistance to someone as none of the therapists at my clinic had ever dealt with fat pad impingement before and I found it hard to locate good information about the problem.

Thank you.

Hi there, I have just joined this forum, really finding it helpful, good stuffkeep it up.

I am currently treating a patient with anterior knee pain for half a year now, she compliants of anterior knee pain when forcefully straighten knee and that limits her from walking fast and prolong walking. after examination, her signs and symptoms turned out to be a fat pad problem.

What is the management for this condition and what type of exercise should I start her off with?

Thanks

[stargirl]

Hi, would you please be able to elaborate on the link between the association of fat pad syndrome and menstrual cycle? I have infrapatellar fat pad impingement in both knees and this can become extremely painful in line with my menstrual cycle. Some months it can be hard to stand and walk. I and am trying to understand the link and what I can do about this. My consultant and physio are unaware of the reason and this is the first time I have come across someone mention that the 2 things may be linked. Any guidance would therefore be very much appreciated! Many thanks for your help.

- - - Updated - - -

hi all
since its felt as a fat pad syndrome,the line of management will be a bit different.as all know,fad pad syndrome has an indirect association with the menstural cycle.history regarding it becomes relevant.
the pain and associated symptoms arises when effusion in the infrapatellar region lift the fat pad up due to the density difference.this come into contact with the highly innervated and sensitive synovial membrane.
so to relieve the symptoms there should be minimising of contact between the fat pad and synovial membrane.
so the treatment plan include
taping technique
management directed to reduce effusion
activity modification
avoiding of position which causes excess contact of fat pad with synovium