J Orthop Sports Phys Ther. 2003 Jan; 33(1): 33-9.

Treatment of fabella syndrome with manual therapy: a case report.

Zipple JT, Hammer RL, Loubert PV.

Program in Physical Therapy, School of Rehabilitation and Medical Sciences, Central Michigan University, Mount Pleasant, MI 48858, USA. tim.zipple@cmich.edu

STUDY DESIGN: Clinical case report. OBJECTIVES: To educate clinicians about fabella syndrome as a possible cause for posterolateral knee pain and dysfunction. Also to describe a physical therapy intervention strategy for posterolateral knee pain secondary to hypomobility or malposition of a fabella. BACKGROUND: A 44-year-old, physically fit, Caucasian male with a 10-year history of left posterolateral knee pain and functional limitations during athletic activities, walking, and activities of daily living presented for evaluation and treatment. He had previously experienced relief of symptoms after experimenting with a mechanical maneuver administered by his wife. METHODS AND MEASURES: A thorough examination for strength, range of motion, and accessory motions was performed. A fabella was palpable in the lateral head of the gastrocnemius muscle and a provisional diagnosis of fabella syndrome was made. While in a prone position, the patient received soft tissue mobilization of the lateral gastrocnemius, followed by medial, lateral, and inferior glides of the fabella. RESULTS: The patient reported an immediate reduction in posterolateral knee pain and demonstrated a 30 degrees increase in active knee flexion. CONCLUSIONS: Physical therapists may be unaware that fabella syndrome is a possible source of posterolateral knee pain and dysfunction. This simple manual therapy intervention was effective in reducing symptoms of pain and increasing tolerance for activities involving knee flexion, extension, and rotation. Physical therapists may wish to add this diagnosis and the corresponding examination and intervention techniques to their management strategy for patients with fabella syndrome.