Test your knowledge: the tibiofibular joint

Sometimes, this joint is the cause of lateral knee pain and therefore it may not be neglected in your clinical examination of knee pain. Numerous pathological disorders can be found at this joint but most of the time there is a hypomobility of this joint due to tension in the lower extremity kinetic chain.This however is only a hypothesis, which is subject to debate. What is your opinion on the relation of proximal tibiofibular joint problems to lateral knee pain? What are the most common tibiofibular joint disorders?

 

Answer:

The three most common disorders of the proximal tibiofibular joint are osteoarthritis (osteophytes), ganglion cysts and trauma. But neoplasms and synovitis can also be present in and around the joint.

Nevertheless, these are all medical diagnoses, and we as physiotherapists often hypothesize as to what may be the cause of problems. So, there could be a hypo- or hypermobility of this joint due to hypertension of the biceps femoris muscle, the triceps surae, the popliteus muscle and so on. The mechanism can also work the other way around: an initial knee problem may be the source of pain and dysfunction of the proximal tibiofibular joint.In my opinion lateral and posterolateral knee pain can be managed through examining the whole knee and kinetic chain of the lateral tract and related structures (up to sacroiliac joint and down to the foot – pes planus et cetera) AND examining the PTFJ (Proximal tibiofibular Joint). Note that there can be a variety of anatomic variations to this joint, so you have to feel and test in which way and orientation you have to mobilize the joint, if needed. Note that this is an opinion and no “evidence based practice or medicine”!