Patellofemoral pain

A common running injury for about 10% of the active population is pain located around or right beneath the knee cap. This pain is referred to as Patellofemoral pain. This is also a common pain for those who may not be so active and come be acquired from normal daily actives. Typically, this pain condition develops slowly over time but can also come about by the result of an trauma injury or surgery due to injuries of the knee. Sadly, Patellofemoral pain tends to become chronic for many and more than 70% of people still suffer with pain 15+ years after the first diagnosis. This is because this pain is due to biomechanics issues which cause symptoms which are considered complex and are different from one patient to the next.

Patellofemoral pain

This blog was created by Dr. Kalika, director of NYDNR. Having worked with some of the top in his field but just to name one for example, Prof. Vladimir of the renowned Czech School of Rehabilitation. Prof. Vladimir was called “the world’s leader in the field of physiotherapy and rehabilitation of the 20th century.” by the Spine magazine. Dr. Kalika is proficient in imaging with diagnostic ultrasound and has worked with some of the top sports medicine specialists in Europe. He has a deep understanding of medical diagnosis because of his immense knowledge of orthopedic as well as sports medicine practices.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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