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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2017

Open Access 01-12-2017 | Research article

Distribution and symmetrical patellofemoral pain patterns as revealed by high-resolution 3D body mapping: a cross-sectional study

Authors: S. A. Boudreau, E. N. Kamavuako, M. S. Rathleff

Published in: BMC Musculoskeletal Disorders | Issue 1/2017

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Abstract

Background

Detailed pain mapping of extent and distribution in individuals with patellofemoral pain (PFP) within and around a complex structure such as the knee has yet to be explored.

Methods

Perceptions of on-going pain from adolescents and young adults (N = 35) with long-standing (>10 months) PFP were collected on high-resolution 3D digital body-schema of the knees. Location, area of pain, pain intensity, laterality, worse side of knee pain, symptom duration, and symmetry in bilateral knee pain were recorded. A threshold for naturally occurring variations in symmetrical knee pain drawings were collected from 18 healthy controls and used in combination with the development a symmetry index (0–1) to create a fuzzy rule for classifying symmetrical and non-symmetrical PFP patterns as compared to a PFP expert. The symmetry index was computed and tested using a correlation coefficient alone or in combination with the Jaccard index and the true and false positive rates (TPR and FPR, respectively) determined.

Results

The peripatellar region was the common report of pain location however, novel and nonconforming PFP patterns were identified and the majority of individuals (22 of 27) with bilateral PFP expressed highly-symmetric mirror-image pain. Individuals with symptom duration of 5 years or more had a greater area of pain, compared to those with symptoms for less than 5 years. The total area of pain was correlated to symptom duration for those with extended symptoms durations and a progression towards an “O” shaped pattern emerged. A TPR of 100% for identifying symmetrical knee pain patterns was found however the expert PFP tended to be stricter, as reflected in FPR of 20%.

Conclusions

A high proportion of PFP patterns or symptoms occur in mirrored locations and are exceptionally symmetrical, and long duration of symptoms appear to converge to an ‘O’ shape. Classifying symmetrical pain patterns is subjective however simple fuzzy rules and correlations can be used to increase objectivity. This study highlights a gap in knowledge of PFP symptom presentation, reveals what may be a natural progression of symptoms, and provides valuable clinical insight for both pain management and treatment.
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Literature
1.
Rathleff MS, Roos EM, Olesen JL, Rasmussen S. High prevalence of daily and multi-site pain--a cross-sectional population-based study among 3000 Danish adolescents. BMC Pediatr. 2013;13:191. 2431-13-191.CrossRefPubMedPubMedCentral
2.
Fairbank JC, Pynsent PB, van Poortvliet JA, Phillips H. Mechanical factors in the incidence of knee pain in adolescents and young adults. J Bone Joint Surg (Br). 1984;66(5):685–93.
3.
Stovitz SD, Pardee PE, Vazquez G, Duval S, Schwimmer JB. Musculoskeletal pain in obese children and adolescents. Acta Paediatr. 2008;97(4):489–93.CrossRefPubMed
4.
Rathleff MS, Skuldbol SK, Rasch MN, Roos EM, Rasmussen S, Olesen JL. Care-seeking behaviour of adolescents with knee pain: a population-based study among 504 adolescents. BMC Musculoskelet Disord. 2013;14:225. 2474-14-225.CrossRefPubMedPubMedCentral
5.
Molgaard C, Rathleff MS, Simonsen O. Patellofemoral pain syndrome and its association with hip, ankle, and foot function in 16- to 18-year-old high school students: a single-blind case-control study. J Am Podiatr Med Assoc. 2011;101(3):215–22.CrossRefPubMed
6.
Rathleff MS, Roos EM, Olesen JL, Rasmussen S, Arendt-Nielsen L. Lower mechanical pressure pain thresholds in female adolescents with patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2013;43(6):414–21.CrossRefPubMed
7.
Witvrouw E, Callaghan MJ, Stefanik JJ, Noehren B, Bazett-Jones DM, Willson JD, et al. Patellofemoral pain: consensus statement from the 3rd International Patellofemoral Pain Research Retreat held in Vancouver, September 2013. Br J Sports Med. 2014;48(6):411–4.CrossRefPubMed
8.
Rathleff MS, Rasmussen S, Olesen JL. Unsatisfactory long-term prognosis of conservative treatment of patellofemoral pain syndrome. Ugeskr Laeger. 2012;174(15):1008–13.PubMed
9.
Rathleff MS, Roos EM, Olesen JL, Rasmussen S. Exercise during school hours when added to patient education improves outcome for 2 years in adolescent patellofemoral pain: a cluster randomised trial. Br J Sports Med. 2015;49(6):406–12.CrossRefPubMed
10.
Nimon G, Murray D, Sandow M, Goodfellow J. Natural history of anterior knee pain: a 14- to 20-year follow-up of nonoperative management. J Pediatr Orthop. 1998;18(1):118–22.PubMed
11.
Utting MR, Davies G, Newman JH. Is anterior knee pain a predisposing factor to patellofemoral osteoarthritis? Knee. 2005;12(5):362–5.CrossRefPubMed
12.
Haim A, Yaniv M, Dekel S, Amir H. Patellofemoral pain syndrome: validity of clinical and radiological features. Clin Orthop Relat Res. 2006;451:223–8.CrossRefPubMed
13.
Dye SF. The pathophysiology of patellofemoral pain: a tissue homeostasis perspective. Clin Orthop Relat Res. 2005;436(436):100–10.CrossRef
14.
Dixit S, DiFiori JP, Burton M, Mines B. Management of patellofemoral pain syndrome. Am Fam Physician. 2007;75(2):194–202.PubMed
15.
Boudreau SA, Badsberg S, Christensen SW, Egsgaard LL. Digital pain drawings: assessing touch-screen technology and 3D body schemas. Clin J Pain. 2015;7.
16.
Thompson LR, Boudreau R, Hannon MJ, Newman AB, Chu CR, Jansen M, et al. The knee pain map: reliability of a method to identify knee pain location and pattern. Arthritis Rheum. 2009;61(6):725–31.CrossRefPubMedPubMedCentral
17.
Dye SF, Vaupel GL, Dye CC. Conscious neurosensory mapping of the internal structures of the human knee without intraarticular anesthesia. Am J Sports Med. 1998;26(6):773–7.PubMed
18.
Naslund JE, Odenbring S, Naslund UB, Lundeberg T. Diffusely increased bone scintigraphic uptake in patellofemoral pain syndrome. Br J Sports Med. 2005;39(3):162–5.CrossRefPubMedPubMedCentral
19.
Draper CE, Fredericson M, Gold GE, Besier TF, Delp SL, Beaupre GS, et al. Patients with patellofemoral pain exhibit elevated bone metabolic activity at the patellofemoral joint. J Orthop Res. 2012;30(2):209–13.CrossRefPubMed
20.
Draper CE, Quon A, Fredericson M, Besier TF, Delp SL, Beaupre GS, et al. Comparison of MRI and (1)(8)F-NaF PET/CT in patients with patellofemoral pain. J Magn Reson Imaging. 2012;36(4):928–32.CrossRefPubMedPubMedCentral
21.
Boudreau S, Spence R, Vasov G, Egsgaard L. Feature extraction Apps for pain profiles. Biosystems & Biorobotics. 2014;7:853.CrossRef
22.
Choi S, Cha S, Tappert C. A survey of binary similarity and distance measures. The Journal of Sytemics, cybernetics and informatics, JSCI. 2010;8(1).
23.
Brushoj C, Holmich P, Nielsen MB, Albrecht-Beste E. Acute patellofemoral pain: aggravating activities, clinical examination, MRI and ultrasound findings. Br J Sports Med. 2008;42(1):64,7. discussion 67.
24.
Palmer H. Pain charts; a description of a technique whereby functional pain may be diagnosed from organic pain. N Z Med J. 1949;48(264):187–213.PubMed
25.
Koltzenburg M, Wall PD, McMahon SB. Does the right side know what the left is doing? Trends Neurosci. 1999;22(3):122–7.CrossRefPubMed
26.
Shenker N, Haigh R, Roberts E, Mapp P, Harris N, Blake D. Pain, nuerogenic inflammation and symmetry in medical practice. Pain reviews. 2001;8:27–34.CrossRef
27.
Milligan ED, Twining C, Chacur M, Biedenkapp J, O'Connor K, Poole S, et al. Spinal glia and proinflammatory cytokines mediate mirror-image neuropathic pain in rats. J Neurosci. 2003;23(3):1026–40.PubMed
28.
Helliwell PS, Hetthen J, Sokoll K, Green M, Marchesoni A, Lubrano E, et al. Joint symmetry in early and late rheumatoid and psoriatic arthritis: comparison with a mathematical model. Arthritis Rheum. 2000;43(4):865–71.CrossRefPubMed
29.
Maleki J, LeBel AA, Bennett GJ, Schwartzman RJ. Patterns of spread in complex regional pain syndrome, type I (reflex sympathetic dystrophy). Pain. 2000;88(3):259–66.CrossRefPubMed
30.
Zangger P, Keystone EC, Bogoch ER. Asymmetry of small joint involvement in rheumatoid arthritis: prevalence and tendency towards symmetry over time. Joint Bone Spine. 2005;72(3):241–7.CrossRefPubMed
31.
Wylde V, MacKichan F, Bruce J, Gooberman-Hill R. Assessment of chronic post-surgical pain after knee replacement: development of a core outcome set. Eur J Pain. 2015;19(5):611–20.CrossRefPubMed
32.
Twining CM, Sloane EM, Milligan ED, Chacur M, Martin D, Poole S, et al. Peri-sciatic proinflammatory cytokines, reactive oxygen species, and complement induce mirror-image neuropathic pain in rats. Pain. 2004;110(1–2):299–309.CrossRefPubMed
33.
Song Y, Stal PS, Yu JG, Forsgren S. Bilateral increase in expression and concentration of tachykinin in a unilateral rabbit muscle overuse model that leads to myositis. BMC Musculoskelet Disord. 2013;14:134. 2474-14-134.CrossRefPubMedPubMedCentral
34.
Decaris E, Guingamp C, Chat M, Philippe L, Grillasca JP, Abid A, et al. Evidence for neurogenic transmission inducing degenerative cartilage damage distant from local inflammation. Arthritis Rheum. 1999;42(9):1951–60.CrossRefPubMed
35.
Riddle DL, Makowski M. Knee pain patterns and associations with pain and function in persons with or at risk for symptomatic radiographic osteoarthritis: a cross-sectional analysis. J Rheumatol. 2015;42(12):2398–403.CrossRefPubMedPubMedCentral
36.
Lluch Girbes E, Duenas L, Barbero M, Falla D, Baert IA, Meeus M, et al. Expanded distribution of pain as a sign of central sensitization in individuals with symptomatic knee osteoarthritis. Phys Ther. 2016;96(8):1196–207.CrossRefPubMed
37.
Graven-Nielsen T, Arendt-Nielsen L. Assessment of mechanisms in localized and widespread musculoskeletal pain. Nat Rev Rheumatol. 2010;6(10):599–606.CrossRefPubMed
Metadata
Title
Distribution and symmetrical patellofemoral pain patterns as revealed by high-resolution 3D body mapping: a cross-sectional study
Authors
S. A. Boudreau
E. N. Kamavuako
M. S. Rathleff
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2017
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-017-1521-5

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