Medscape is available in 5 Language Editions – Choose your Edition here.


Iliotibial Band Friction Syndrome Workup

  • Author: Steven J Karageanes, DO, FAOASM; Chief Editor: Thomas M DeBerardino, MD  more...
Updated: Apr 11, 2016

Laboratory Studies

Basic preoperative laboratory tests are indicated, including the following:

  • Complete blood count (CBC)
  • Electrolytes
  • Blood urea nitrogen (BUN)
  • Creatinine level
  • Liver function tests (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 magnetic resonance imaging (MRI) and ultrasonography should be considered.


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 iliotibial band (ITB) friction syndrome (ITBFS).

Magnetic resonance imaging

MRI[20, 21, 22]  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, whereas the chronic stage can be associated with bursal fluid and ITB thickening.


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.

Contributor Information and Disclosures

Steven J Karageanes, DO, FAOASM Director of Sports Medicine, St Mary Mercy Hospital Livonia; Regional Assistant Dean, Kansas City University of Medicine and Biosciences; Clinical Assistant Professor, Michigan State University College of Osteopathic Medicine

Steven J Karageanes, DO, FAOASM is a member of the following medical societies: American Medical Association, American Osteopathic Academy of Sports Medicine, American Osteopathic Association, Michigan State Medical Society

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, Michigan State Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Thomas M DeBerardino, MD Orthopedic Surgeon, The San Antonio Orthopaedic Group; Research Director, BRIO of the San Antonio Orthopaedic Group; Consulting Surgeon, Sports Medicine, Arthroscopy and Reconstruction of the Knee, Hip and Shoulder, Team Physician; Adjunct Associate Professor, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine

Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Herodicus Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Arthrex, Inc.; Ivy Sports Medicine; MTF; Aesculap; The Foundry, Cotera; ABMT<br/>Received research grant from: Histogenics; Cotera; Arthrex.

Additional Contributors

Dennis P Grogan, MD Clinical Professor (Retired), Department of Orthopedic Surgery, University of South Florida College of Medicine; Orthopedic Surgeon, Department of Orthopedic Surgery, Shriners Hospital for Children of Tampa

Dennis P Grogan, MD is a member of the following medical societies: American Medical Association, American Orthopaedic Association, Scoliosis Research Society, Irish American Orthopaedic Society, Pediatric Orthopaedic Society of North America, American Academy of Orthopaedic Surgeons, American Orthopaedic Foot and Ankle Society, Eastern Orthopaedic Association

Disclosure: Nothing to disclose.


Cynthia Kooima, MD Resident 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.

  1. Ellis R, Hing W, Reid D. Iliotibial band friction syndrome--a systematic review. Man Ther. 2007 Aug. 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). 2008 Jun 24. [Medline].

  3. Kirk KL, Kuklo T, Klemme W. Iliotibial band friction syndrome. Orthopedics. 2000 Nov. 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. 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. 2006 Mar. 208(3):309-16. [Medline].

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

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

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

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

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

  11. Strauss EJ, Kim S, Calcei JG, Park D. Iliotibial band syndrome: evaluation and management. J Am Acad Orthop Surg. 2011 Dec. 19(12):728-36. [Medline].

  12. Baker RL, Souza RB, Fredericson M. Iliotibial band syndrome: soft tissue and biomechanical factors in evaluation and treatment. PM R. 2011 Jun. 3(6):550-61. [Medline].

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

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

  15. Ho GW1, Howard TM. Greater trochanteric pain syndrome: more than bursitis and iliotibial tract friction. Curr Sports Med Rep. Sept-Oct 2012. 11(5):232-8. [Medline].

  16. Taketomi S1, Inui H, Hirota J, Nakamura K, Sanada T, Masuda H, et al. Iliotibial band irritation caused by the EndoButton after anatomic double-bundle anterior cruciate ligament reconstruction: report of two cases. Knee. August 2013. 20:291-4. [Medline].

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

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

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

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

  21. 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. 1999 Jul. 212(1):103-10. [Medline].

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

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

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

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

  26. Cowden CH 3rd, Barber FA. Arthroscopic treatment of iliotibial band syndrome. Arthrosc Tech. 2013 Dec. 19;3(1):57-60. [Medline]. [Full Text].

  27. Michels F1, Jambou S, Allard M, Bousquet V, Colombet P, de Lavigne C. An arthroscopic technique to treat the iliotibial band syndrome. Knee Surg Sports Traumatol Arthrosc. 2009 March. 17(3):233-6. [Medline].

  28. Weiner DS1, Tank JC, Jonah D, Morscher MA, Krahe A, Kopits S, et al. An operative approach to address severe genu valgum deformity in the Ellis-van Creveld syndrome. J Child Orthop. 2014 Feb. 8(1):61-9. [Medline].

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

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

Illustration of the friction point at the lateral epicondyle prominence. Note the shift in position of the iliotibial band from anterior to posterior as the knee moves into flexion, drawing the iliotibial band across the prominence.
Lateral hip stabilizers.
Iliotibial band noted prominently along the lateral thigh.
Iliotibial band at the lateral femoral epicondyle, with the posterior fibers denoted.
The Thomas test can be used to evaluate restriction in the iliotibial band, hip flexors, and rectus femoris.
Resection of lateral synovial fold through arthroscopic knee procedure. Courtesy of Elsevier, Inc (Cowden CH 3rd, Barber FA. Arthroscopic treatment of iliotibial band syndrome. Arthrosc Tech. Feb 2014;3(1):e57-60).
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.