Iliotibial Band Syndrome
Original Editors - Yves Demol, Aurelie Ackerman
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Definition/Description[edit | edit source]
An iliotibial friction syndrome is most frequently seen in military personnel, cyclists, runners or other athletes submitted to repetitive motion of the knee.[1](6) This repetitive motion is responsible for excessive friction between the lateral epicondyle and the iliotibial tract. It is considered as an overuse injury and is often concomitant with underlying weakness of hip abductor muscles.(3) Pain appears in the region of the lateral femur epicondyle or a bit inferior to it.(2) During a physical examination we see an important tenderness of the lateral aspect of the knee. This tenderness is found superior to the joint line and inferior to the lateral femoral epicondyle.[1]
Clinically Relevant Anatomy[edit | edit source]
The iliotibial tract has its origin on the lateral border of the iliac crest. It is composed of dense fibrous connective tissue that appears from the M. tensor fasciae latae, the gluteal fascia and M. gluteus maximus. It descends vertically at the lateral aspect of the thigh, between the layers of the superficial fascia, and inserts on Gerdy’s tubercle and the lateral proximal aspect of the fibular head.(1)(5)Moreover the ilitibial tract becomes denser in its distal portion and gives an expansion to the lateral border of the patella. In this distal portion, the iliotibial tract covers the lateral femoral epicondyle, The iliotibial tract is stretched by M. gluteus maximus and M. tensor fasciae latae, both inserting on the proximal part of the tract. (1)
Epidemiology /Etiology[edit | edit source]
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Characteristics/Clinical Presentation[edit | edit source]
In many instances the anamnesis will already provide an excellent basis for suspicion of this syndrome. As mentioned above, repetitive activities involving knee flexion-extension are usually reported, as is a burning pain at the level of (or just underneath) the lateral femoral epicondyle. The diagnosis in patients with this syndrome is based on different symptoms.(3) Among the characteristics, we find an exercise-related tenderness over the lateral femoral epycondyle.(3) The patients experience, on regular basis, an acute, burning pain when pressure is applied on the epycondyle with the knee in flexion and in extension.(6) Sign of inflammation due to the friction between tract and the lateral epicondyle during extension and flexion of the knee can also be found.[1](3) There is pain on the lateral aspect of the knee during running, increasing in intensity while running down hill. Pain is also exacerbated when running a long distance.(4)
Differential Diagnosis[edit | edit source]
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Diagnostic Procedures[edit | edit source]
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Outcome Measures[edit | edit source]
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Examination[edit | edit source]
- Force of hip abduction:
The force of hip abductors can be decreased. These muscles should thus be tested.(3)
- Noble compression test:
This test starts in supine posture and a knee flexion of 90 degrees. As the patient extends the knee the assessor applies pressure to the lateral femoral epicondyle. If this induces pain over the lateral femoral epicondyle near 30 degrees of flexion, the test is considered positive.(6)
- Ober test:
The patient is lying on his side with the injured extremity facing upwards. The knee is flexed at 90 degrees and the hip in abduction and extension, the thigh is maintained in line with the trunk. The patient is invited to adduct the thigh as far as possible. The test is positive if the patient cannot adduct farther than the examination table. A positive Ober test indicates a short / tense ilio-tibial band or tensor fasciae latae, which is frequently related to the friction syndrome.[1](7)
Both the Noble compression test and the Ober test can be use to examine a patient with a suspicion of Iliotibial friction syndrome. The result will be more obvious when we combine the two into one special test. For this, the position of the Ober test is adopted and compression is applied on the lateral epicondyle during passive knee extension and flexion. Moving the knee can produce more strain on the injured structures and can help to reproduce the symptoms of the patient if the combination does not . Medial patellar glide can also increase the symptoms (by tending the patellar expansion of the iliotibial band) and can reveal the precise localization while lateral glides reduces them. An internal rotation of the tibia when the knee is moved from flexion to extension can also produce the symptoms. A combination of the Nobel and Ober tests with an unloaded knee or in a weight bearing position can also be done the reproduce the symptoms. (6)
Medical Management
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Physical Therapy Management
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Key Research[edit | edit source]
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Clinical Bottom Line[edit | edit source]
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