Popliteus Tendinopathy

Definition/Description
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Theoretically speaking, popliteus tendinitis, also known as popliteus tendon tenosynovitis is a gap in the tendon of the popliteus. Popliteus is quite an uncommon pathology which often occurs in athletes and people with a history of other knee ligament injuries after trauma. It is a relatively unusual condition in non-athletes without a history of Knee traumas.[1][2]

Clinically Relevant Anatomy[edit | edit source]

The popliteus muscle’s function is endo-rotation the lower part of your leg when walking, as also it is a very crucial part for the stabilisation of the knee. The popliteus muscle provides forward stabilisation, as also the stabilisation of the retraction of the backside of the knee joint and the lateral meniscus during the flexion of the knee. [1][3]

Epidemiology /Etiology[edit | edit source]

Common causes of posterolateral knee joint injury, such as popliteus tendinitis, are either a direct varus force, while the tibia is externally rotated, or a sudden forced knee hyperextension with the tibia internally rotated.[1][3][2]

Characteristics/Symptoms[edit | edit source]

Symptoms of popliteus tendinitis are inflammation, pain, swelling, or even tenderness outside of the knee. If the patient continues to load its knee, symptoms will worsen and scar tissue can form, which makes physical activity to be extra painful.[4][3][2]

Differential Diagnosis[edit | edit source]

The diagnosis should be 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.[5]

Treatment
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The treatment for popliteus tendinitis includes rest, ice application, 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[6].

Physical Therapy Management
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The key to physical therapy should be to train patients to perform tasks such as these using a
technique that is natural for them. One should avoid tissue stresses associated with moving too far into a genu varus or valgus posture, or fast tissue stresses with patients with poor dynamic lower extremity postural stability. [3]

Strengthening Exercises[edit | edit source]

Here are three exercises to strengthen the affected popliteus muscle (Nyland et al).

Exercise 1[edit | edit source]

A) Attache a resistance band on to the forefoot of the non–weight-bearing leg (NWBL).
B) The foot on the NWBL moves behind the stance leg via external rotation of the hip and knee flexion.
C) The foot of the NWBL continues to move behind the stance leg with increasing internal tibial rotation.
D) Completion of the concentric exercise. The return to start position provides an eccentric muscle effort.

File:AAA.jpg

Exercise 2[edit | edit source]

In this exercise, the patient has to do a quick loading-unloading step exercise. This means that the exercise will be done as fast as possible, without losing the integrity of the exercise.

A) Put the foot of the NWBL posterior and lateral of the stance leg
B) Put the foot of the NWBL forward
C) Put the foot of the NWBL posterior and medial of the stance leg
D) Idem B
E) Put the foot of the NWBL sideward of the stance leg

File:AAB.jpg

Exercise 3[edit | edit source]

A stepping task performed on an unstable surface.

File:AAC.jpg

References
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  1. 1.0 1.1 1.2 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. 2.0 2.1 2.2 S M Blake & N J Treble; Case Report: Popliteus tendon tenosynovitis; Br J Sports Med; 2005, 39
  3. 3.0 3.1 3.2 3.3 John Nyland et al.; Anatomy, Function, and Rehabilitation of the Popliteus Musculotendinous Complex; Journal of Orthopaedic & Sports Physical Therapy; March 2005; 35(3); 165-179 [A2]
  4. http://www.itendonitis.com/popliteus-tendonitis.html
  5. http://www.merckmanuals.com/professional/sec21/ch324/ch324o.html
  6. http://www.freemd.com/tendinitis-of-the-popliteus-tendon/treatment.htm