Nevrodynamiske tester ved patellofemorale smerter

Background: Patellofemoral pain syndrom (PFPS) is a common musculoskeletal disorder which can develop to a chronic problem. There is no consensus in medical literature concerning the etiology of PFPS. Recent studies indicate an involvement of the peripheral nervous system around the patella. Neurodynamic tests are used to explore the mechanosensitivity of peripheral nerves. Several studies have shown relationship between increased mechanosensitivity and musculoskeletal problems in the upper extremity. No such studies has yet been done concerning PFPS. Aims: The main objective of this pilot study was to explore if there was increased mechanosensitivity in the femoral nerve in patients with unilateral PFPS. Methods: This cross- sectional study included 12 patiens with unilateral PFPS. They were tested with two different neurodynamic test ad mod. Butler. The pain-free knee was used as a healthy control. Result: Several criterions for interpretation of the neurodynamic test showed an increased mechanosensitivity of the femoral nerve in patients with unilateral PFPS. The affected knee was more paintful during the test, compared to the painfree knee ( p<0.05 Wilcoxon). The range of motion showed a decreased range in the painful knee. The area of symptoms was more often reproduced in the knee area, and structural differentiation by neck flexion increased the symptoms more often when testing the PFPS knee. Conclusion: This pilot study demonstrates an altered mechanosensitivity in PFPS. Clinicians may consider to use neurodynamic tests when examination the PFPS patient. Further studies are needed to investigate the nevrodynamic tests and the relationship between PFPS and mechanosensitivity.Bakgrunn: Patellofemorale smerter (PFS) er en vanlig muskelskjelett plage som kan bli langvarig og aktivitets hemmende. Det er lite konsensus i den medisinske litteraturen om årsak til PFS. Flere studier har vist at det foreligger nevrogene substanser og nevrologiske endringer i området rundt patella. Dette støtter teorien om at PFS kan skyldes en nevrogen dysfunksjon. For å måle nervevevets mekanosensitivitet benyttes nevrodynamiske tester. Studier har funnet sammenheng mellom lesjoner i overekstremiteten og økt mekanosensitivitet i nervevev. Tilsvarende studier er ennå ikke gjort på PFS. Hensikt og problemstilling: Hensikten med denne pilotstudien er å undersøke om det foreligger økt mekanosensitivitet i nervus femoralis hos pasienter med unilateral PFS. Metode: Det ble gjennomført en tverrsnittstudie der 12 pasienter med unilateral PFS ble testet med to nevrodynamiske tester ad modum Butler. Pasientens friske ben ble benyttes som kontroll. Resultat: Summen av de ulike kriterier for mekanosensitivitet viste at det forelå et klinisk bilde på økt mekanosensitivitet i nervus femoralis på affisert side. Det var økt smerte respons ved test sammenliknet med smertefri side (p