eMedicine Specialties > Orthopedic Surgery > Knee

Iliotibial Band Friction Syndrome: Workup

Author: Steven Karageanes, DO, Director, Primary Care Sports Medicine Fellowship, Director, Sports Medicine Education, Center for Orthopedics and Neuroscience; Department of Medical Education, Oakwood Healthcare System
Coauthor(s): Cynthia Kooima, MD, Staff Physician, Department of Orthopedic Surgery, Henry Ford Hospital; Terrence Lock, MD, Senior Consulting Surgeon, Department of Orthopedic Surgery, Henry Ford Hospital
Contributor Information and Disclosures

Updated: Jan 8, 2009

Workup

Laboratory Studies

  • Perform basic preoperative laboratory tests, such as CBC count, electrolytes, BUN, creatinine level, and LFTs.

Imaging Studies

  • A complete history and physical examination should provide enough information that imaging beyond radiography is typically not necessary. If the diagnosis is unclear or conservative treatment fails, then MRI and ultrasonography should be considered.
  • Radiography: This study is used to rule out fractures, osteophytes, or osteochondrotic lesions. Alignment and soft tissue swelling may be evaluated also. Radiographic findings usually are unremarkable in ITBFS.
  • MRI14,15,16
    • MRI can be used to effectively exclude other pathology, such as lateral meniscus tear, lateral collateral ligament sprain, patellofemoral subluxation, chondromalacia patellae, biceps or popliteus tendinitis, meniscal cysts, and osteochondritis dissecans.
    • MRI can reveal diffuse signal deep to the ITB in the recess just proximal to the lateral femoral condyle. Reactive signal in the periosteum of the condyle and thickening of the ITB can be observed as well, but no pathology typically is observed in the knee joint.
    • The stage of development of ITBFS may impact the findings seen on MRI. Acute cases may have an ill-defined signal abnormality beneath the ITB; progression of the syndrome can be associated with increasing signal changes superficial to the ITB, while the chronic stage can be associated with bursal fluid and ITB thickening.
  • Ultrasonography
    • Ultrasonography is useful in evaluating cystic masses and fluid in the lateral synovial recess (LSR).
    • It is effective in revealing the dynamic motion of the ITB through knee flexion and extension, thus allowing visualization of the impingement.

Diagnostic Procedures

  • Lidocaine can be injected for diagnostic purposes if a localized source of pain is suspected.

Histologic Findings

Tissue from the lateral synovial recess demonstrates hyperplasia and inflammation. ITB tissue may exhibit tendinosis.

More on Iliotibial Band Friction Syndrome

Overview: Iliotibial Band Friction Syndrome
Workup: Iliotibial Band Friction Syndrome
Treatment: Iliotibial Band Friction Syndrome
Follow-up: Iliotibial Band Friction Syndrome
Multimedia: Iliotibial Band Friction Syndrome
References
Further Reading
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References

  1. Ellis R, Hing W, Reid D. Iliotibial band friction syndrome--a systematic review. Man Ther. Aug 2007;12(3):200-8. [Medline].

  2. Hamill J, Miller R, Noehren B, Davis I. A prospective study of iliotibial band strain in runners. Clin Biomech (Bristol, Avon). Jun 24 2008;[Medline].

  3. Kirk KL, Kuklo T, Klemme W. Iliotibial band friction syndrome. Orthopedics. Nov 2000;23(11):1209-14; discussion 1214-5; quiz 1216-7. [Medline].

  4. Lebsack D, Gieck J, Saliba E. Iliotibial band friction syndrome. JNATA;1990:356-61.

  5. Krivickas LS. Anatomical factors associated with overuse sports injuries. Sports Med. Aug 1997;24(2):132-46. [Medline].

  6. Biundo JJ Jr, Irwin RW, Umpierre E. Sports and other soft tissue injuries, tendinitis, bursitis, and occupation-related syndromes. Curr Opin Rheumatol. Mar 2001;13(2):146-9. [Medline].

  7. DeLee JC, Drez D. Orthopaedic Sports Medicine: Principles and Practice. Vol 2. WB Saunders Co;1994:1251-1252.

  8. Noble CA. Iliotibial band friction syndrome in runners. Am J Sports Med. Jul-Aug 1980;8(4):232-4. [Medline].

  9. Orchard JW, Fricker PA, Abud AT, Mason BR. Biomechanics of iliotibial band friction syndrome in runners. Am J Sports Med. May-Jun 1996;24(3):375-9. [Medline].

  10. Linenger JM, Christensen CP. Is iliotibial band syndrome overlooked?. Phys Sports Med. 1992;20:98-108.

  11. Fredericson M, Cookingham CL, Chaudhari AM, et al. Hip abductor weakness in distance runners with iliotibial band syndrome. Clin J Sport Med. Jul 2000;10(3):169-75. [Medline].

  12. Fredericson MF, Guillet M, DeBenedictis L. Quick solutions for iliotibial band syndrome. Phys Sports Med. 2000;28(2):53-68.

  13. Fairclough J, Hayashi K, Toumi H, Lyons K, Bydder G, Phillips N, et al. The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome. J Anat. Mar 2006;208(3):309-16. [Medline].

  14. Ekman EF, Pope T, Martin DF, Curl WW. Magnetic resonance imaging of iliotibial band syndrome. Am J Sports Med. Nov-Dec 1994;22(6):851-4. [Medline].

  15. Muhle C, Ahn JM, Yeh L, et al. Iliotibial band friction syndrome: MR imaging findings in 16 patients and MR arthrographic study of six cadaveric knees. Radiology. Jul 1999;212(1):103-10. [Medline].

  16. Murphy BJ, Hechtman KS, Uribe JW, et al. Iliotibial band friction syndrome: MR imaging findings. Radiology. Nov 1992;185(2):569-71. [Medline].

  17. Drogset JO, Rossvoll I, Grontvedt T. Surgical treatment of iliotibial band friction syndrome. A retrospective study of 45 patients. Scand J Med Sci Sports. Oct 1999;9(5):296-8. [Medline].

  18. Sangkaew C. Surgical treatment of iliotibial band friction syndrome with the mesh technique. Arch Orthop Trauma Surg. May 2007;127(4):303-6. [Medline].

  19. Barber FA, Boothby MH, Troop RL. Z-plasty lengthening for iliotibial band friction syndrome. J Knee Surg. Oct 2007;20(4):281-4. [Medline].

  20. Martens M, Libbrecht P, Burssens A. Surgical treatment of the iliotibial band friction syndrome. Am J Sports Med. Sep-Oct 1989;17(5):651-4. [Medline].

  21. Holmes JC, Pruitt AL, Whalen NJ. Iliotibial band syndrome in cyclists. Am J Sports Med. May-Jun 1993;21(3):419-24. [Medline].

  22. Nemeth WC, Sanders BL. The lateral synovial recess of the knee: anatomy and role in chronic Iliotibial band friction syndrome. Arthroscopy. Oct 1996;12(5):574-80. [Medline].

  23. Firer P. Results of surgical management for iliotibial band friction syndrome. Clin J Sport Med. 1992;2:247-50.

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Further Reading


Related eMedicine topics:

 Iliotibial Band Syndrome (Physical Medicine and Rehabilitation)

Iliotibial Band Syndrome (Sports Medicine)

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Keywords

iliotibial band friction syndrome, ITBFS, iliotibial band syndrome, iliotibial band syndrome rehabilitation,  jogger's knee, knee pain, knee injury

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Contributor Information and Disclosures

Author

Steven Karageanes, DO, Director, Primary Care Sports Medicine Fellowship, Director, Sports Medicine Education, Center for Orthopedics and Neuroscience; Department of Medical Education, Oakwood Healthcare System
Steven Karageanes, DO is a member of the following medical societies: American Medical Association, American Osteopathic Association, and Michigan State Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Cynthia Kooima, MD, Staff Physician, Department of Orthopedic Surgery, Henry Ford Hospital
Cynthia Kooima, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

Terrence Lock, MD, Senior Consulting Surgeon, Department of Orthopedic Surgery, Henry Ford Hospital
Terrence Lock, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Medical Association, and Michigan State Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Dennis P Grogan, MD, Clinical Professor, Department of Orthopedic Surgery, University of South Florida College of Medicine; Chief of Staff, Department of Orthopedic Surgery, Shriners Hospital for Children of Tampa
Dennis P Grogan, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Eastern Orthopaedic Association, Irish American Orthopaedic Society, Pediatric Orthopaedic Society of North America, and Scoliosis Research Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Thomas M DeBerardino, MD, Director, John A Feagin, Jr, Sports Medicine Fellowship at West Point, Associate Professor of Orthopedic Surgery, Uniformed Services University of the Health Sciences and Keller Army Community Hospital
Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, and American Orthopaedic Society for Sports Medicine
Disclosure: Arthrex, Inc. Grant/research funds None; Arthrex, Inc. Honoraria Speaking and teaching; Genzyme Biosurgery. Inc. Grant/research funds Other; Musculoskeletal Transplant Foundation Grant/research funds Other; Histogenics Grant/research funds None

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Carlos J Lavernia, MD, FAAOS, Adjunct Clinical Professor, Department of Orthopedic Surgery, University of Miami School of Medicine; Medical Director, Orthopedic Institute at Mercy Hospital
Carlos J Lavernia, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, Arthritis Foundation, Biomedical Engineering Society, Florida Orthopaedic Society, and Orthopaedic Research Society
Disclosure: Zimmer Stock Implant Designer

 
 
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