Medication Summary
The goals of pharmacotherapy are to reduce morbidity and prevent complications.
Nonsteroidal anti-inflammatory drugs
Class Summary
Have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known, but they may inhibit cyclooxygenase (COX) activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions.
Ibuprofen (Advil, Motrin)
DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Naproxen (Naprelan, Naprosyn, Anaprox)
For relief of mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing activity of cyclo-oxygenase, which results in a decrease of prostaglandin synthesis.
Ketoprofen (Oruvail, Orudis, Actron)
For relief of mild to moderate pain and inflammation. Small dosages initially are indicated in small and elderly patients and in those with renal or liver disease.
Doses over 75 mg do not increase therapeutic effects. Administer high doses with caution, and closely observe patient for response.
Cyclooxygenase-2 Inhibitors
Class Summary
COX-2 inhibitors are a new class of NSAIDs that report a lower incidence of GI side effects, such as gastritis and ulcers. COX-2 inhibitors may be indicated in patients who require anti-inflammatory medications but who have a history of gastric ulcers.
Celecoxib (Celebrex)
For relief of mild to moderate pain. Primarily inhibits COX-2. COX-2 is considered an inducible isoenzyme, induced during pain and with inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID-related GI toxicity. At therapeutic concentrations, COX-1 isoenzyme is not inhibited, thus GI toxicity may be decreased. Seek lowest dose of celecoxib for each patient.
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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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Iliotibial band at the lateral femoral condyle, with the posterior fibers denoted.
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Iliotibial band noted prominently along the lateral thigh.
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Lateral hip stabilizers.
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The Thomas test can be used to evaluate restriction in the iliotibial band and hip flexors.
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The Ober test.
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This illustration demonstrates active stretching of the iliotibial band (ITB). The athlete stands a comfortable distance from a wall and, with the contralateral knee extended, leans the proximal shoulder against the wall to stretch the ipsilateral ITB.
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This illustration demonstrates iliotibial band syndrome stretching performed in a side-lying position.
