eMedicine Specialties > Physical Medicine and Rehabilitation > Lower Limb Musculoskeletal Conditions

Iliotibial Band Syndrome: Differential Diagnoses & Workup

Author: John M Martinez, MD, Medical Director, Primary Care Sports Medicine, Coastal Sports and Wellness Medical Center
Coauthor(s): Kenneth Honsik, MD, Consulting Staff, Department of Primary Care Sports Medicine, Kaiser Permanente; Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Contributor Information and Disclosures

Updated: Apr 17, 2009

Differential Diagnoses

Hamstring Strain
Osteoarthritis
Medial Collateral and Lateral Collateral Ligament Injury
Overuse Injury
Meniscal Injury
Patellofemoral Syndrome
Myofascial Pain
Trochanteric Bursitis

Other Problems to Be Considered

Muscle strain
Degenerative joint disease
Biceps femoris tendinitis
Popliteus tendinitis

Workup

Laboratory Studies

  • Laboratory studies are not indicated for the diagnosis of iliotibial band syndrome. However, laboratory tests may help rule out other sources of knee pain, such as rheumatoid arthritis or a septic joint.

Imaging Studies

  • Imaging tests are not necessary to confirm the diagnosis of iliotibial band syndrome (ITBS). Depending on the findings of the physical examination, the physician may want to obtain radiographs of the knee to rule out other pathology such as a fracture or bone spur. In severe cases, magnetic resonance imaging (MRI) may be helpful in identifying the extent of inflammation of the ITB. Findings on MRI most commonly include thickening of the ITB in the region overlying the lateral femoral condyle and fluid collection underneath the ITB at this area. (See image below and Image 1.)
In this 27-year-old female marathon runner with a...

In this 27-year-old female marathon runner with anterolateral pain superior to the joint line, a coronal fast spin-echo T2-weighted magnetic resonance imaging scan with fat suppression demonstrates edema between the iliotibial band and the lateral femoral condyle (arrow). The edema's location is consistent with a clinical diagnosis of iliotibial band syndrome.

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In this 27-year-old female marathon runner with a...

In this 27-year-old female marathon runner with anterolateral pain superior to the joint line, a coronal fast spin-echo T2-weighted magnetic resonance imaging scan with fat suppression demonstrates edema between the iliotibial band and the lateral femoral condyle (arrow). The edema's location is consistent with a clinical diagnosis of iliotibial band syndrome.


Procedures

  • Local injection with corticosteroids may be indicated in patients with iliotibial band syndrome (ITBS) who do not respond to stretching, physical therapy, and exercise modification.5 If the patient still does not improve, then tendon-lengthening surgery with excision of the damaged ITB may be required.
  • Surgery for the correction of ITBS has typically been an open procedure using a Z-plasty technique, although small prospective studies have used arthroscopy to create a diamond-shaped defect in the ITB.7,8,9

Histologic Findings

Histologic changes associated with acute and chronic inflammation of the iliotibial band are observed.

More on Iliotibial Band Syndrome

Overview: Iliotibial Band Syndrome
Differential Diagnoses & Workup: Iliotibial Band Syndrome
Treatment & Medication: Iliotibial Band Syndrome
Follow-up: Iliotibial Band Syndrome
Multimedia: Iliotibial Band Syndrome
References
Further Reading
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References

  1. Fredericson M, Weir A. Practical management of iliotibial band friction syndrome in runners. Clin J Sport Med. May 2006;16(3):261-8. [Medline].

  2. Fredericson M, Wolf C. Iliotibial band syndrome in runners: innovations in treatment. Sports Med. 2005;35(5):451-9. [Medline].

  3. Hamill J, Miller R, Noehren B, Davis I. A prospective study of iliotibial band strain in runners. Clin Biomech (Bristol, Avon). Oct 2008;23(8):1018-25. [Medline].

  4. Grau S, Maiwald C, Krauss I, Axmann D, Horstmann T. The influence of matching populations on kinematic and kinetic variables in runners with iliotibial band syndrome. Res Q Exerc Sport. Dec 2008;79(4):450-7. [Medline].

  5. Khaund R, Flynn SH. Iliotibial band syndrome: a common source of knee pain. Am Fam Physician. Apr 15 2005;71(8):1545-50. [Medline]. [Full Text].

  6. Grau S, Krauss I, Maiwald C, et al. Hip abductor weakness is not the cause for iliotibial band syndrome. Int J Sports Med. Jul 2008;29(7):579-83. [Medline].

  7. Ilizaliturri VM Jr, Martinez-Escalante FA, Chaidez PA, et al. Endoscopic iliotibial band release for external snapping hip syndrome. Arthroscopy. May 2006;22(5):505-10. [Medline].

  8. Hariri S, Savidge ET, Reinold MM, Zachazewski J, Gill TJ. Treatment of recalcitrant iliotibial band friction syndrome with open iliotibial band bursectomy: indications, technique, and clinical outcomes. Am J Sports Med. Mar 13 2009;[Medline].

  9. Michels F, 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. Mar 2009;17(3):233-6. [Medline].

  10. Adams WB. Treatment options in overuse injuries of the knee: patellofemoral syndrome, iliotibial band syndrome, and degenerative meniscal tears. Curr Sports Med Rep. Oct 2004;3(5):256-60. [Medline].

  11. 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].

  12. Brosseau L, Casimiro L, Milne S. Deep transverse friction massage for treating tendinitis. Cochrane Database Syst Rev. 2002;CD003528. [Medline].

  13. Faraj AA, Moulton A, Sirivastava VM. Snapping iliotibial band. Report of ten cases and review of the literature. Acta Orthop Belg. Feb 2001;67(1):19-23. [Medline].

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

  15. Garrick JG, Webb DR. Sports Injuries. Diagnosis and Management. Philadelphia, Pa: WB Saunders; 1999.

  16. Jones RL. The injured or painful knee and its evaluation. In: Clinics in Family Medicine. 1999 Dec:209.

  17. Kendal FP, et al. Muscles: Function and Testing. 4th ed. Baltimore, Md: Williams & Wilkins; 1993.

  18. Noble CA. The treatment of iliotibial band friction syndrome. Br J Sports Med. Jun 1979;13(2):51-4. [Medline]. [Full Text].

  19. Sutker AN, Barber FA, Jackson DW, Pagliano JW. Iliotibial band syndrome in distance runners. Sports Med. Nov-Dec 1985;2(6):447-51. [Medline].

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Keywords

iliotibial band syndrome, hip pain, iliotibial band, iliotibial, IT band, ITBS, iliotibial syndrome, running injury, IT band syndrome, pain in hip, IT band pain, greater trochanter, ITB syndrome, lateral femoral condyle, IT band stretch, iliotibial band friction syndrome, IT band knee, overuse injury, iliotibial band tendonitis, trochanteric bursitis, lateral knee pain

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Contributor Information and Disclosures

Author

John M Martinez, MD, Medical Director, Primary Care Sports Medicine, Coastal Sports and Wellness Medical Center
John M Martinez, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, and American Medical Society for Sports Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Kenneth Honsik, MD, Consulting Staff, Department of Primary Care Sports Medicine, Kaiser Permanente
Disclosure: Nothing to disclose.

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

Medical Editor

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM, President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine
Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, International Association for the Study of Pain, Physiatric Association of Spine, Sports and Occupational Rehabilitation, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michael T Andary, MD, MS, Residency Program Director, Professor, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine
Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists
Disclosure: allergan Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Rene Cailliet, MD, Professor-Chairman Emeritus, Department of Rehabilitation Medicine, University of Southern California School of Medicine; Former Director, Department of Rehabilitation Medicine, Santa Monica Hospital Medical Center
Rene Cailliet, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Pain Society, Association of American Medical Colleges, International Association for the Study of Pain, and Pan American Medical Association
Disclosure: Nothing to disclose.

 
 
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