Iliotibial band syndrome

Dr Henry Knipe and Dr Saqba Farooq et al.

Iliotibial band (friction) syndrome is a common cause of lateral knee pain related to intense physical activity resulting in chronic inflammation.

Commonly affect young patients who are physically active, most often long distance runners or cyclists. The exact prevalence is unknown, but one study has found the prevalence among actively training marines to be higher than 20% 5.  Iliotibial band syndrome accounts for 12% of running-related overuse injuries 4.

Classically, Iliotibial band syndrome is diagnosed by history and physical examination. Pain at the lateral knee joint is the presenting symptom with point tenderness 1-2 cm above the lateral joint line. Pain is usually worse with downhill running and increases throughout an episode of activity 4.

When the knee flexes, the iliotibial band (ITB) moves posteriorly along the lateral femoral epicondyle. When the band is excessively tight or stressed, the ITB rubs against the epicondyle irritating the lateral synovial recess. 

The following physical factors are reported to be associated with the development of the syndrome 4:

  • limb length discrepancy
  • genu varum
  • overpronation
  • hip adductor weakness
  • myofascial restriction

The histologic analysis demonstrates inflammation and hyperplasia in the synovium. 

Allows visualisation of the impingement by assessing dynamic motion of the ITB through knee flexion and extension.

MRI is reserved for when the diagnosis is unclear and to exclude other etiologies of lateral knee pain such as a meniscal tear or lateral collateral ligament injury.

MR findings of ITBS include ill-defined signal abnormality within the fatty soft tissues interposed between the ITB and lateral femoral condyle, that is low signal on T1 and high on T2 weighted sequences, in keeping with oedema/fluid.

Cystic areas representing primary or secondary (adventitious) bursae may be identified.

Chronic MRI findings include thickening of the ITB and increased T2 signal intensity superficial to the ITB are occasionally seen

Lateral synovial recess may mimic as a joint fluid with soft tissue inflammatory changes. This is made easier by understanding that the anterior lateral synovial recess is located anterior to the lateral femoral epicondyle, in contrast to the inflammatory changes of ITBFS, which frequently overlie and extend posteriorly to the epicondyle

Initial treatment is conservative, consisting of physical therapy, anti-inflammatory medication, and steroid injections 3.

Surgical treatment is reserved only for those who fail conservative treatment and includes resection of the posterior aspect of the ITB 3.

General imaging differential considerations include:

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Article information

rID: 10044
Section: Syndromes
Tag: knee
Synonyms or Alternate Spellings:
  • Iliotibial Band Friction Syndrome
  • ITBS
  • Iliotibial band syndrome (ITBS)

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