Patellofemoral pain and asymmetrical hip rotation.
OBJECTIVE
Patellofemoral joint problems are the most common overuse injury of the lower extremity, and altered femoral or hip rotation may play a role in patellofemoral pain. The purpose of this case report is to describe the evaluation of and intervention for a patient with asymmetrical hip rotation and patellofemoral pain.


METHODS
The patient was a 15-year-old girl with an 8-month history of anterior right knee pain, without known trauma or injury. Prior to intervention, her score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was 24%. Right hip medial (internal) rotation was less than left hip medial rotation, and manual muscle testing showed weakness of the right hip internal rotator and abductor muscles. The intervention was aimed at increasing right hip medial rotation, improving right hip muscle strength (eg, the muscle force exerted by a muscle or a group of muscles to overcome a resistance), and eliminating anterior right knee pain.


RESULTS
After 6 visits (14 days), passive left and right hip medial rotations were symmetrical, and her right hip internal rotator and abductor muscle grades were Good plus. Her WOMAC score was 0%.


CONCLUSIONS
The patient had right patellofemoral pain and an uncommon pattern of asymmetrical hip rotation, with diminished hip medial rotation and excessive hip lateral (external) rotation on the right side. The patient's outcomes suggest that femoral or hip joint asymmetry may be related to patellofemoral joint pain.
Cibulka
Michael T
MT
Jefferson County Rehabilitation and Sports Clinic, 1330 YMCA Dr, Suite 1200, Festus, MO 63028, USA. mcibulka@earthlink.net
Threlkeld-Watkins
Julie
J
D000293:Adolescent; D001696:Biomechanical Phenomena; D012090:Cumulative Trauma Disorders / Q000150:complications; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D005684:Gait; D006621:Hip Joint / Q000503:physiopathology*; D006801:Humans; D007718:Knee Injuries / Q000150:complications; D010147:Pain Measurement; D010173:Palpation; D046788:Patellofemoral Pain Syndrome / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology* / Q000534:rehabilitation*; D010347:Patient Care Planning; D010808:Physical Examination; D011187:Posture; D011379:Prognosis; D016059:Range of Motion, Articular; D012399:Rotation; D012720:Severity of Illness Index; D016896:Treatment Outcome