Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Popliteus Tenosynovitis

SYMPTOMS

Gradual or acute onset of localised exercise-induced pain at the lateral posterior aspect of the knee with or without preceding trauma. It is most common in pivoting sports like football or rugby or in cross-country running.

AETIOLOGY

This is an inflammatory response around the popliteus tendon in the posterior lateral intra-articular part of the knee. This condition typically occurs as a result of sudden changes in training habits, such as an increase in intensity or amount of impact, or after a direct impact, such as a kick.

CLINICAL FINDINGS

There is tenderness on palpation in the posterior and lateral joint line over the femur condyle that is aggravated by a resistance test.

INVESTIGATIONS

X-ray is normal. MRI may show superficial sub-chondral oedema and can usually exclude a lateral meniscal tear. Ultrasound is also helpful in the diagnosis. Repeating the clinical test before and after 1 ml of local anaesthetic is injected into the most painful spot can usually help make the diagnosis clear.

TREATMENT

This injury most often responds to conservative treatment, including modification of training and stretching exercises of the knee muscles. There is seldom an indication for surgery but in unclear situations, with effusion, arthroscopy may be needed to verify the diagnosis and administer a minor dose of cortisone.

REFERRALS

Refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon for planning of a three months’ return programme back to sport. Refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon if non-operative treatment fails.

EXERCISE PRESCRIPTION

Most forms of exercise are allowed but temporary avoidance of jumping, twisting and pivoting activities may help.

EVALUATION OF TREATMENT OUTCOMES

Normal clinical symptoms and signs.

DIFFERENTIAL DIAGNOSES

Stress fracture (MRI differentiates), lateral meniscal tear (MRI or arthroscopy differentiate), iliotibial band traction syndrome (clinical differentiation and no effusion).

PROGNOSIS

Excellent.

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