By Tomás Ryan BSc.AHS, Ph.Th. MIAPT, Registered Physical Therapist (MIAPT) based in Thurles
Pain at the front of the knee when walking, squating downwards and going up and down stairs may indicate the present of an irritated synovium plica in the knee joint. The symptoms are often confused with patella tendonitis or a medial meniscus tear which are a more common knee pathology.
What is Synovium Plica Syndrome
Synovium is is a layer of connective tissue that lines the bones of the inner area of the knee joint this is akin to a coat of paint on the walls of room. The Synovium secretes or produces fluids that help to keep the knee joint oiled and moveable. If the Synovium develops a fold or a crease it is known as a Plica. A synovium Plica occurs most commonly on the inner border of the knee joint against the inner or medial edge of the patella (knee cap). The synovium develops a fold or a tickness and protrudes underneath the surface of the knee cap. In many people the synovium plica can be symptomless. However it can become irritated by a fall or trauma to the knee cap region, leading to the plica becoming inflammed and enlarged causing pain during knee movement. It can also compress local nerve endings beneath the inside border of the knee cap thus causing local tenderness.
Signs & Symptoms
Knee Locking sensation with a feeling of instability in the knee joint
Medial (inner side of knee) Knee Pain and swelling
Can be tender to touch on the inner joint line of the joint adjacent to the kneecap
Pain in the knee in a prolonged sitting position
Climbing stairs causes frontal knee pain
Pain when squatting on the knee
Treatment & Management
As a Physical therapist I would focus treatment on the following points.
Temporary Avoidance of the pain aggravating activities is important such as not climbing stairs for under it becomes painfree. Daily sessions of 15-20 minutes of cooling on inflamed tissue coupled with anti-inflammatory treatment. Balancing exercises alongside trunk and knee strengthening exercises with maximising knee load within a painfree zone. Teaching the patient to self-tape the patella can also aid recovery by distressing sensitive synovium. In worst case scenarios, arthroscopic surgery is required to help remove the plica.
Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy (MIAPT) and is based in Thurles. Contact Number: 0504 26672. Email; firstname.lastname@example.org
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