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4/3: Elderly/Orthopaedics Y3/4 - MSK [11] (check ILOs) > [23] Iliotibial Band Syndrome > Flashcards

[23] Iliotibial Band Syndrome Flashcards

1
Q

What is the iliotibial band also termed?

A

The iliotibial tract

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2
Q

What is the iliotibial band?

A

A branch of longitudinal fibres that form the shared aponeurosis of the tensoe fasciae latae and gluteus maximus

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3
Q

Where does the iliotibial band extend?

A

From the iliac tubercle to the anterolateral tubercle of the tibia

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4
Q

What does inflammation of the tibial band result in?

A

Condition termed iliotibial band syndrome

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5
Q

What is the importance of iliotibial band syndrome?

A

It is the most common cause of lateral knee pain in athletes

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6
Q

What is the incidence of iliotibial band syndrome?

A

1.6-12%

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7
Q

What is the pathophysiology of iliotibial band syndrome?

A

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

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8
Q

Who is iliotibial band syndrome common in?

A

Those who have regular exercise involving repetitive flexion and extension of the knee, commonly runners, weightlifters, or cyclists

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9
Q

What are the anatomical risk factors for iliotibial band syndrome?

A

Genu varum
Excessive internal tibial torsion
Foot pronation
Hip abductor weakness

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10
Q

What is the classical clinical feature in iliotibial band syndrome?

A

Lateral knee pain

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11
Q

What makes the pain worse in iliotibial band syndrome?

A

Exercise, particularly running downhill or on an excessive camber

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12
Q

What is it important to assess for in the history in iliotibial band syndrome?

A

Previous trauma

Features of osteoarthritis

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13
Q

Why is it important to assess for previous trauma in the history for iliotibial band syndrome?

A

Because trauma is more suggestive of ligamentous knee injury

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14
Q

What may be found on examination in iliotibial band syndrome?

A

Examination may often be unremarkable, only with pain localising to the lateral aspect of hte knee

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15
Q

What special tests aid in making the diagnosis of iliotibial band syndrome?

A

Nobles test

Renne test

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16
Q

How is Nobles test performed?

A

The patient lies in a supine position, and the examiner places a finger on the lateral femoral condyle, and then the knee slowly extends

17
Q

What is a positive Nobles test?

A

When pain is felt at 30 degrees

18
Q

What happens at 30 degrees of knee extension that causes pain in Nobles test?

A

The ITB passes over the lateral femoral condyle

19
Q

How is Renne test performed?

A

The examiner stands in front of the affected knee, and puts pressure on the lateral epicondyle, with the patient then asked to squat

20
Q

What is a positive Renne test?

A

The presence of pain at 30 degrees of flexion

21
Q

What are the main differential diagnoses of iliotibial band syndrome?

A

Degenerative joint disease
Fractures
Ligamentous injury

22
Q

How can a diagnosis of iliotibial band syndrome be made?

A

Clinically

23
Q

What imaging might be used in iliotibial band syndrome?

A

Plain radiograph

MRI imaging

24
Q

What can imaging be used for in suspected iliotibial band syndrome?

A

To exclude other pathology if history and examination are inconclusive

25
Q

What is the problem with the management of iliotibial band syndrome?

A

There is little evidence as to the best management

26
Q

How can most patients with iliotibial band syndrome be managed?

A

Modification of activity

Use of regular simple analgesics during period of acute pain

27
Q

What can the longer-term management of iliotibial band syndrome involve?

A

Local steroid injections

Physiotherapy

28
Q

What is the aim of local steroid injections in iliotibial band syndrome?

A

To reduce localised inflammation

29
Q

What does physiotherapy include in iliotibial band syndrome?

A

A period of stretching followed by strengthening of the muscles around the knee joint

30
Q

When is surgical management of iliotibial band syndrome indicated?

A

Only if the patient remains symptomatic or functionally limited after 6 months despite all other treatment

31
Q

What does the surgical management of iliotibial band syndrome involve?

A

Release of the iliotibial band from its attachments from the patella

32
Q

What does the release of the iliotibial band from its attachment from the patella allow?

A

Greater range of movement

33
Q

What approach can be taken in the surgical release of the iliotibial band?

A

Either percutaneous or via open approach

4/3: Elderly/Orthopaedics Y3/4 - MSK [11] (check ILOs) (38 decks)

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