Physical therapy examination and management of 34-year-old female with patellofemoral pain and instability secondary to Ehlers-Danlos syndrome: case report




Cummings, Katie

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Angelo State University. Department of Physical Therapy.


This case report presents the physical therapy plan of care of a patient with knee pain and instability and a history of Ehlers-Danlos Syndrome (EDS). Patellofemoral knee pain and instability can occur due to a strength imbalance of quadricep muscles that subsequently causes the patella to migrate out of the trochlear groove. This case is unique due to the patient’s high physical activity level, motivation to improve, and symptoms experienced from EDS. It is not only important to understand treatment for patellofemoral pain and instability but also acknowledge this disorder affecting the integrity of joints, connective tissue, and level of fatigue. S.S. is a 34-year-old female who presents to physical therapy for initial evaluation of right knee pain and instability. She was diagnosed with EDS seven years ago and explains that she feels general laxity and occasionally experiences flare ups. However, her knee pain increased about two months ago when the patient felt her knee “sub-lux” during a tennis match. She described a stabbing pain in the medial aspect of her knee that presents with quick lateral movements. S.S. received a PT diagnosis of Patellofemoral Pain Syndrome (PFPS) and instability. Upon initial evaluation, patient presented with decreased strength and range of motion of right knee. S.S. was exposed to a modality, strengthening exercises, and neuromuscular reeducation to treat PFPS. She experienced less patellofemoral pain after isometric tendon loading and dry needling. Additionally, patient increased in medial quad and hip strength with open and closed chain exercises. Successfully treating an orthopedic injury requires multiple interventions. Key Words: Ehlers-Danlos Syndrome, Patellofemoral pain, Patellofemoral instability