Iliotibial Band Friction Syndrome Workup

Updated: May 18, 2022
  • Author: Steven J Karageanes, DO, FAOASM; Chief Editor: Thomas M DeBerardino, MD, FAAOS, FAOA  more...
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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

In patients with iliotibial band (ITB) friction syndrome (ITBFS), 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 (US) 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 ITBFS.

Magnetic resonance imaging

MRI [28, 29, 30]  can be an effective means of excluding other pathology (eg, lateral meniscus tear, lateral collateral ligament sprain, patellofemoral subluxation, chondromalacia patellae, biceps or popliteus tendinitis, meniscal cysts, and osteochondritis dissecans). It 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.


US 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.



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


Histologic Findings

Tissue from the LSR demonstrates hyperplasia and inflammation. ITB tissue may exhibit tendinosis.