ChiroACCESS Clinical Review

Patellofemoral Pain Syndrome: Diagnosis

This information is provided to you for use in conjunction with your clinical judgment and the specific needs of the patient.

Lead Author(s): 

Dwain M. Daniel, D.C.


How this evidence was rated:

Strength of Recommendation Taxonomy (SORT)

Published on

June 15, 2009

Text Size:     
Patellofemoral pain syndrome (PFPS) is a condition that is most commonly diagnosed based on patient history, observation and physical examination. There is no gold standard for diagnosis. The etiology of PFPS is multifactorial and although arriving at a diagnosis is relatively easy, determining the etiology, which leads to proper treatment, is more difficult.

The patient experiencing PFPS often complains of pain under or around the patella which is often exacerbated by climbing or descending stairs. Pain or stiffness after sitting with the knees bent is common. Swelling is uncommon (1).

The diagnosis portion of this monograph will be divided into two sections. The first will discuss commonly used clinical tests and procedures to help arrive at a diagnosis of PFPS. The second section will assist the reader in determining etiology which will aid in choosing an appropriate treatment plan.

The information relating to reliability, sensitivity, specificity or likelihood ratios for these tests are very limited.

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Dixit S, DiFiori JP, Burton M, Mines B. Management of patellofemoral pain syndrome. Am Fam Physician 2007 Jan 15;75(2):194-202.


Nijs J, Van Geel C, Van der aC, Van d, V. Diagnostic value of five clinical tests in patellofemoral pain syndrome. Man Ther 2006 Feb;11(1):69-77.


Fredericson M, Yoon K. Physical examination and patellofemoral pain syndrome. Am J Phys Med Rehabil 2006 Mar;85(3):234-43.


Hand CJ, Spalding TJ. Association between anatomical features and anterior knee pain in a "fit" service population. J R Nav Med Serv 2004;90(3):125-34.


Niskanen RO, Paavilainen PJ, Jaakkola M, Korkala OL. Poor correlation of clinical signs with patellar cartilaginous changes. Arthroscopy 2001 Mar;17(3):307-10.


Aglietti P, Insall JN, Cerulli G. Patellar pain and incongruence. I: Measurements of incongruence. Clin Orthop Relat Res 1983 Jun;(176):217-24.


Messier SP, Davis SE, Curl WW, Lowery RB, Pack RJ. Etiologic factors associated with patellofemoral pain in runners. Med Sci Sports Exerc 1991 Sep;23(9):1008-15.


Emami MJ, Ghahramani MH, Abdinejad F, Namazi H. Q-angle: an invaluable parameter for evaluation of anterior knee pain. Arch Iran Med 2007 Jan;10(1):24-6.


Caylor D, Fites R, Worrell TW. The relationship between quadriceps angle and anterior knee pain syndrome. J Orthop Sports Phys Ther 1993 Jan;17(1):11-6.


Thomee R, Renstrom P, Karlsson J, Grimby G. Patellofemoral pain syndrome in young women. I. A clinical analysis of alignment, pain parameters, common symptoms and functional activity level. Scand J Med Sci Sports 1995 Aug;5(4):237-44.


Witvrouw E, Lysens R, Bellemans J, Cambier D, Vanderstraeten G. Intrinsic risk factors for the development of anterior knee pain in an athletic population. A two-year prospective study. Am J Sports Med 2000 Jul;28(4):480-9.


Haim A, Yaniv M, Dekel S, Amir H. Patellofemoral pain syndrome: validity of clinical and radiological features. Clin Orthop Relat Res 2006 Oct;451:223-8.


Loudon JK, Wiesner D, Goist-Foley HL, Asjes C, Loudon KL. Intrarater Reliability of Functional Performance Tests for Subjects With Patellofemoral Pain Syndrome. J Athl Train 2002 Sep;37(3):256-61.

 [ Full-Text Link ]


Pagenstert GI, Bachmann M. [Clinical examination for patellofemoral problems]. Orthopade 2008 Sep;37(9):890-903.


Doberstein ST, Romeyn RL, Reineke DM. The diagnostic value of the Clarke sign in assessing chondromalacia patella. J Athl Train 2008 Apr;43(2):190-6.


Johnson LL, van Dyk GE, Green JR, III, Pittsley AW, Bays B, Gully SM, et al. Clinical assessment of asymptomatic knees: comparison of men and women. Arthroscopy 1998 May;14(4):347-59.


Prins MR, van der WP. Females with patellofemoral pain syndrome have weak hip muscles: a systematic review. Aust J Physiother 2009;55(1):9-15.


Waryasz GR, McDermott AY. Patellofemoral Pain Syndrome (PFPS): A systematic review of anatomy and potential risk factors. Dyn Med 2008 Jun 26;7(1):9.


Boling MC, Padua DA, Alexander CR. Concentric and eccentric torque of the hip musculature in individuals with and without patellofemoral pain. J Athl Train 2009 Jan;44(1):7-13.


Smith AD, Stroud L, McQueen C. Flexibility and anterior knee pain in adolescent elite figure skaters. J Pediatr Orthop 1991 Jan;11(1):77-82.


Piva SR, Fitzgerald K, Irrgang JJ, Jones S, Hando BR, Browder DA, et al. Reliability of measures of impairments associated with patellofemoral pain syndrome. BMC Musculoskelet Disord 2006;7:33.

 [ Full-Text Link ]


Puniello MS. Iliotibial band tightness and medial patellar glide in patients with patellofemoral dysfunction. J Orthop Sports Phys Ther 1993 Mar;17(3):144-8.


Winslow J, Yoder E. Patellofemoral pain in female ballet dancers: correlation with iliotibial band tightness and tibial external rotation. J Orthop Sports Phys Ther 1995 Jul;22(1):18-21.


Hudson Z, Darthuy E. Iliotibial band tightness and patellofemoral pain syndrome: a case-control study. Man Ther 2009 Apr;14(2):147-51.


Gautam VK, Anand S. A new test for estimating iliotibial band contracture. J Bone Joint Surg Br 1998 May;80(3):474-5.


Melchione WE, Sullivan MS. Reliability of measurements obtained by use of an instrument designed to indirectly measure iliotibial band length. J Orthop Sports Phys Ther 1993 Sep;18(3):511-5.


Duffey MJ, Martin DF, Cannon DW, Craven T, Messier SP. Etiologic factors associated with anterior knee pain in distance runners. Med Sci Sports Exerc 2000 Nov;32(11):1825-32.