[23] Iliotibial Band Syndrome Flashcards
What is the iliotibial band also termed?
The iliotibial tract
What is the iliotibial band?
A branch of longitudinal fibres that form the shared aponeurosis of the tensoe fasciae latae and gluteus maximus
Where does the iliotibial band extend?
From the iliac tubercle to the anterolateral tubercle of the tibia
What does inflammation of the tibial band result in?
Condition termed iliotibial band syndrome
What is the importance of iliotibial band syndrome?
It is the most common cause of lateral knee pain in athletes
What is the incidence of iliotibial band syndrome?
1.6-12%
What is the pathophysiology of iliotibial band syndrome?
The exact pathophysiology is unknown, however it is thought to be linked to repetitive flexion and extension of the knee, causing impingement of the band against the lateral femoral condyle
Who is iliotibial band syndrome common in?
Those who have regular exercise involving repetitive flexion and extension of the knee, commonly runners, weightlifters, or cyclists
What are the anatomical risk factors for iliotibial band syndrome?
Genu varum
Excessive internal tibial torsion
Foot pronation
Hip abductor weakness
What is the classical clinical feature in iliotibial band syndrome?
Lateral knee pain
What makes the pain worse in iliotibial band syndrome?
Exercise, particularly running downhill or on an excessive camber
What is it important to assess for in the history in iliotibial band syndrome?
Previous trauma
Features of osteoarthritis
Why is it important to assess for previous trauma in the history for iliotibial band syndrome?
Because trauma is more suggestive of ligamentous knee injury
What may be found on examination in iliotibial band syndrome?
Examination may often be unremarkable, only with pain localising to the lateral aspect of hte knee
What special tests aid in making the diagnosis of iliotibial band syndrome?
Nobles test
Renne test
How is Nobles test performed?
The patient lies in a supine position, and the examiner places a finger on the lateral femoral condyle, and then the knee slowly extends
What is a positive Nobles test?
When pain is felt at 30 degrees
What happens at 30 degrees of knee extension that causes pain in Nobles test?
The ITB passes over the lateral femoral condyle
How is Renne test performed?
The examiner stands in front of the affected knee, and puts pressure on the lateral epicondyle, with the patient then asked to squat
What is a positive Renne test?
The presence of pain at 30 degrees of flexion
What are the main differential diagnoses of iliotibial band syndrome?
Degenerative joint disease
Fractures
Ligamentous injury
How can a diagnosis of iliotibial band syndrome be made?
Clinically
What imaging might be used in iliotibial band syndrome?
Plain radiograph
MRI imaging
What can imaging be used for in suspected iliotibial band syndrome?
To exclude other pathology if history and examination are inconclusive
What is the problem with the management of iliotibial band syndrome?
There is little evidence as to the best management
How can most patients with iliotibial band syndrome be managed?
Modification of activity
Use of regular simple analgesics during period of acute pain
What can the longer-term management of iliotibial band syndrome involve?
Local steroid injections
Physiotherapy
What is the aim of local steroid injections in iliotibial band syndrome?
To reduce localised inflammation
What does physiotherapy include in iliotibial band syndrome?
A period of stretching followed by strengthening of the muscles around the knee joint
When is surgical management of iliotibial band syndrome indicated?
Only if the patient remains symptomatic or functionally limited after 6 months despite all other treatment
What does the surgical management of iliotibial band syndrome involve?
Release of the iliotibial band from its attachments from the patella
What does the release of the iliotibial band from its attachment from the patella allow?
Greater range of movement
What approach can be taken in the surgical release of the iliotibial band?
Either percutaneous or via open approach
