Popliteus Tendinopathy

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Popliteus tendinitis

Tendon popliteus / poplitea

Definition/Description

Strictly theoretical seen, the popliteus tendinitis is a gap in the tendon of the popliteus.
This tendon starts on the lateral side of the bottom of the femur. On the other side, the tendon is attached on the medial side of the backside of the tibia.
The popliteus muscle is very important when you rotate your knee joint.
Thanks to this muscle, it’s possible to endo-rotate the lowest part of your leg.
But not only for the movement of the knee is this muscle important, it is a very crucial part for the stabilization in the knee.
First it is used to assure the forward stabilization, also for the retraction of the backside of the knee joint of the lateral meniscus during the flexion of the knee.
Finally it guarantees the introduction of the flexion coming from the full extension of the knee. [1]

Clinically Relevant Anatomy

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Epidemiology /Etiology

When the knee rotates too much, there may be a chance that the knee shows some irregular moves. Another problem can be that the soles for your footwear are not equal or of bad quality (the joints of the feet are essential to make sure that the knee joints function perfectly). That’s an example of how tendinition can be caused. [1]

Characteristics/Symptoms

If you have popliteus tendonitis, you may have some inflammation, pain, swelling, or even tenderness outside of your knee. If you ignore the pain and continue to exercise, you could possibly inflame the area and it’ll get worse. Once it worsens, scar tissue can form.

Scar tissue can make permanent exercise and activity be painful. It can also take weeks for you to fully recover from a condition of popliteus tendonitis. [6]

Differential Diagnosis

Recognizing and correctly diagnosing popliteus tendinitis is important because this condition can be painful, may significantly limit athletic performance, and can lead to unnecessary surgery if misdiagnosed. The diagnosis is largely established with a careful history and physical examination. Usually patients have symptoms that include tenderness along the course of the proximal popliteus tendon and pain with resisted external rotation. Treatment is directed at eccentric strengthening of the quadriceps to reduce strain on the popliteus. Most patients respond well to physical therapy and NSAIDs; however, recalcitrant cases may require local corticosteroid injection. [2]

Diagnostic Procedures

There is more than one treatment modality used. It’s the duty of the chiropractors to be aware of other treatments in case that the conservative treatments don’t work or in case that the patients want to know all their possibilities.
In general, NSAIDs (non-steroidal anti-inflammatory drugs) are mostly used to deal with the problem of tendinopathy. As awkward as it may be, there is little evidence to support neither to reject the use of the oral NSAIDs for tendinopathy.
Only for lateral elbow pain cases there are some elements proven that support the use of it.
Another treatment that is often used, is the injection of corticosteroids. But it is not (yet) known how many times an injection is necessary, what the dosages or the intervals are.
So the use of corticosteroids is not the best solution in this case because scientists haven’t found all the details of the medicine.
ESWT (extracorporeal shock wave therapy) is also a way to treat tendinopathy.
It is an ultrasound-guided method that focuses a single-pressure pulse at a specific place.
The shock takes only a couple of microseconds.
It has been proved that this therapy helps to heal the tissue and breaks down the calcific deposits.
On the other hand, there are cases where the opposite effects have been reported.
When the therapy is not effective (after 3 to 6 months) for the treatment of the tendinopathy, a surgery is the best way to solve the problem. Tendonitis is - according to a recent survey – one of the most seen conditions among chiropractors.
Mostly they treat it without any medical co-management. There are several methods which are used by the chiropractors: massage, electrical stimulation, bracing, therapeutic exercises…[1]

Outcome Measures

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Examination

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Treatment

The treatment for popliteus tendinitis includes rest, cold compresses, elevation, an elastic wrap, physical therapy, and nonsteroidal anti-inflammatory medications for pain. Additional treatment for popliteus tendinitis may include oral corticosteroids or corticosteroid injections.[4]

Physical Therapy Management

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Key Research

[1]Mark T. Pfefer, RN, MS, DC,a Stephan R. Cooper, DC,b and Nathan L. Uhl, DCc
Journal of Manipulative and Physiological Therapeutics
Chiropractic Management of Tendinopathy January 2009

Resources

[1] Mark T. Pfefer, RN, MS, DC,a Stephan R. Cooper, DC,b and Nathan L. Uhl, DCc
Journal of Manipulative and Physiological Therapeutics
Chiropractic Management of Tendinopathy January 2009

[2] http://www.merckmanuals.com/professional/sec21/ch324/ch324o.html

[3] Diagnosis and Management
Timothy S. Petsche, MD; F. Harlan Selesnick, MD

[4] http://www.freemd.com/tendinitis-of-the-popliteus-tendon/treatment.htm

[5] Popliteus tendinitis, a new perspective
Murray E. Allen; Gary Ray
Research in Sports Medicine: An International Journal

[6] http://www.itendonitis.com/popliteus-tendonitis.html

[7] Lateral Stabilizing Structures of the Knee: Functional Anatomy and Injuries Assessed

Clinical Bottom Line

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Recent Related Research (from Pubmed)

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References

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