Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Chondromalacia, technically termed chondromalacia patellae, is the most common cause of chronic knee pain. The condition develops due to softening of the cartilage beneath the knee cap (the patella), resulting in small areas of breakdown and pain around the knee. Instead of gliding smoothly over the knee, the knee cap rubs against the thigh bone (the femur) when the knee moves. The changes can range from mild to complete erosion of the cartilage. This process is sometimes referred to as the patellofemoral syndrome.
Chondromalacia commonly occurs in females. Girls in their teens are at elevated risk because the cartilage of the knee is subjected to excessive and uneven pressure due to the structural changes that accompany rapid growth. Chondromalacia may also occur in adults over age 40 as part of the wear-and-tear process that eventually leads to osteoarthritis of the knee joint. Other factors that may precipitate chondromalacia include trauma, overuse, or abnormal forces on the knee joint. It can develop in skiers, runners, cyclists, and soccer players, especially if someone is knock-kneed or flat-footed.
Chondromalacia patella is abnormal softening of the cartilage of the under the kneecap (patella). Chondromalacia patella is the most common cause of
chronic knee pain.
Chondromalacia patella results from degeneration of cartilage due to poor alignment of the kneecap as
it slides over the lower end of the thigh bone (femur). This process is, therefore, sometimes referred to as patellofemoral syndrome.
What are the symptoms of chondromalacia patella?
The symptoms of chondromalacia patella are generally a
vague discomfort of the inner knee area, aggravated by activity (running,
jumping, climbing or descending stairs) or by prolonged sitting with knees in a
moderately bent position (the so called "theater sign" of pain upon arising from
a desk or theater seat). Some patients may also have a vague sense of
"tightness" or "fullness" in the knee area. Occasionally, if chronic symptoms
are ignored, the associated loss of quadriceps (thigh) muscle strength
may cause the leg to "give out." Besides an obvious reduction
in quadriceps muscle mass, mild swelling of the knee area
may occur.
What causes chondromalacia
patella?
The patella (kneecap) is normally pulled over the end of
the femur in a straight line by the quadriceps (thigh) muscle. Patients with
chondromalacia patella frequently have abnormal patellar "tracking" toward the
lateral (outer) side of the femur.
This slightly off-kilter pathway allows the undersurface of
the patella to grate along the femur causing chronic
inflammation and pain. Certain individuals are predisposed
to develop chondromalacia patella: females, knock-kneed or flat-footed runners,
or those with an unusually shaped patella undersurface.
The knee joint is composed of three compartments and ligaments which stabilize the joint. Causes of knee pain may include injury, degeneration, infrequently infection and rarely bone tumors. Although routine x-rays do not revel meniscus tears, they can be used to exclude other problems of the bones and tissues. The knee joint is the most commonly involved joint in rheumatic disease, as well as immune diseases that affect various tissues of the body.
Bursitis of the knee results when any of the three fluid-filled sacs (bursae) become inflamed due to injury or strain. Symptoms include pain, swelling, warmth, tenderness, and redness. Treatment of knee bursitis depends on whether infection is involved. If the knee bursa is not infected, knee bursitis may be treated with ice compresses, rest, and antiinflammatory and pain medications.
Pain management and treatment can be simple or complex, according to its cause. There are two basic types of pain, nociceptive pain and neuropathic pain. Some causes of neuropathic pain includes: complex regional pain syndrome, interstitial cystitis, and irritable bowel syndrome. There are a variety of methods to treat chronic pain, which are dependant on the type of pain experienced.
Regular physical activity can reduce the risk of disease. Regular exercise can also reduce the symptoms of stress and anxiety. There are fitness programs that fit any age or lifestyle.
An MRI (or magnetic resonance imaging) scan is a
radiology technique that uses magnetism, radio waves, and a computer
to produce images of body structures. The MRI scanner is a tube
surrounded by a giant circular magnet. The patient is placed on
a moveable bed that is inserted into the magnet. The magnet creates
a strong magnetic field that aligns the protons of hydrogen atoms,
which are then exposed to a beam of radio waves. This spins the
various protons of the body, and they produce a faint signal
that is detected by the receiver portion of the MRI scanner.
The receiver information is processed by a computer, and an image
is produced.
The image and resolution produced by MRI is quite detailed and can
detect tiny changes of structures within the body. For some procedures, contrast agents, such as gadolinium, are used to increase the accuracy of the images.
Chondromalacia, technically termed chondromalacia patellae, is the most common cause of chronic 
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