Iliotibial Band Syndrome

Question 1

Explain what the iliotibial band is.

Answer 1

A branch of longitudinal fibres that form the shared aponeurosis of tensor fascia latea and gluteus maximus.

Extends from the iliac tubercle to the anterolateral tubercle of the tibia.

Inflammation of this band leads to ITBS.

Question 2

Epidemiology

Answer 2

Most common cause of lateral knee pain in athletes.

The exact pathology is unknown but likely to be repetivive flexion and extension of the knee.

This leads to impingement of the band against lateral femoral condyle.

Question 3

Risk factors

Answer 3

Regular exercise involving repetitive flexion and extension of the knee.

Runners, weightlifters and cyclists.

Anatomical RFs like genu varum, excessive internal tibial torsion, foot pronation, hip abductor weakness.

Question 4

Clinical features

Answer 4

Lateral knee pain

Exacerbated by exercise

A history of frequent exercise or a sudden increase in intensity of exercise is often reported.

Pain may also be worsened running downhill or an excessive camber.

Also ask about any previous trauma (if it could be ligamentous knee injury) or features of OA

Question 5

Examination findings

Answer 5

Often unremarkable

Only with pain localising to lateral aspect of the knee.

Question 6

Specific tests for ITBS

Answer 6

Nobles test

Renne test

Question 7

Explain Nobles test

Answer 7

Patient lies supine (on the back)

Place a finger on the lateral femoral condyle and slowly extend the patient knee.

+ve = Pain is felt at 30 degrees when ITB passes over the lateral femoral condyle.

Question 8

Explain Renne test

Answer 8

Stand infront of the affected knee and put pressure on the lateral epicondyle.

Ask the patient to squat

+ve test = Presence of pain at 30 degrees of flexion

Question 9

Dx

Answer 9

Degenerative joint disease

Fractures

Ligamentous injury

Question 10

Ix

Answer 10

Diagnosis is made clinically

Imaging like X-ray or MRI can be done to exclude other pathology if needed.

Question 11

Conservative management

Answer 11

Modify activities and simple analgesics during periods of acute pain

Longer-term management can include local steroid injection and physio

Advise patient to stretchand do strengthening exercises

Question 12

Indications of surgical management

Answer 12

Patient remains symptomatic or functionally limited for over 6 months despite interventions

Question 13

Explain surgical management

Answer 13

Release of the iliotibial band from its attachments of the patella.

This allows greater range of movement.

This can be done percutaneously or open approach.