The iliotibial band (ITB) friction syndrome is a common overuse injury that results in pain in the lateral knee. The iliotibial band is a thickened strip of fascia lata that inserts into Gerdy's tubercle on the lateral tibial condyle. When the knee is in full extension it is anterior to the lateral femoral condyle, while in flexion it moves posterior to the condyle. This back and forth migration over the condyle can result in friction and inflammation of the band.


Risk factors:

(1) marathon or other long distance running

(2) long distance bicycle racing

(3) long distance hiking

(4) varus alignment of the knee, with internal rotation of the tibia; it is very rare with genu valgus

(5) unequal leg lengths

(6) going up and down hills


Clinical features:

(1) The patient complains of a poorly localized pain in the outer knee over the lateral femoral condyle.

(2) The pain is usually unilateral.

(3) The pain may result in limping

(4) The pain is worse (a) with increasing distance and (b) when going up or down stairs or a hill.

(5) No history of direct or indirect trauma to the knee.

(6) Patients may have focal tenderness at a point over the lateral femoral epicondyle.

(7) The pain can be elicited by having the person (a) bear all of the body weight on the affected limb, (b) bend the knee to 30° flexion, and (c) rock over the top.

(8) positive Ober test (With the subject lying supine the hip is abducted and extended while flexing the ipsilateral knee. Normally the extended hip should passively adduct to neutral with the knee in the midline.)

(9) The iliotibial band can be stretched by (a) having the person stand on the edge of a platform with the foot of the leg to be tested supported, (b) let the opposite hip drop down a few inches without twisting or rotating (the foot will be lower than the platform).

(10) Patients can hop, jog in place, squat and rise without discomfort.

(11) Radiographs of the knee do not show a lesion.


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