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 the image below.
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 physical therapy and exercise modification. [2] If the patient still does not improve, then tendon-lengthening surgery with excision of the damaged ITB may be considered.
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, 26]
Histologic Findings
Histologic changes associated with acute and chronic inflammation of the iliotibial band are observed.
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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.
