Iliotibial Band Syndrome Of The Knee - Everything You Need To Know - Dr. Nabil Ebraheim
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Dr. Ebraheim's animated educational video
Dr. Ebraheim's animated educational video describes iliotibial band syndrome of the knee.
Inflammation and thickening of the iliotibial band result from excessive friction as the iliotibial band slides over the lateral femoral condyle. The iliotibial band is a thick band of fascia that extends along the lateral thigh from the iliac crest to the knee. It inserts into the Gerdy’s tubercle of the tibia.
The iliotibial band is a continuation of the tensor fascia lata muscle. The tensor fascia lata muscle arises from the outer surface of the anterior iliac crest, between the tubercle of the iliac spine and inserts into the iliotibial tract. The gluteus maximus also inserts into the iliotibial band.
Function of the iliotibial band
The IT band extends, abducts and laterally rotates the hip. The IT band also contributes to lateral knee stabilization. The IT band is repeatedly shifted forward and backward across the lateral femoral condyle.
Impingement usually occurs around 30 degrees of knee flexion. There may be swelling, tenderness and crepitus over the lateral femoral condyle. The condition of ITBS around the knee most commonly occurs in runners, cyclists and other athletes undergoing exercise with repetitive knee flexion and extension. The IT band inserts into Gerdy’s tubercle. The pain is proximal to the Gerdy’s tubercle. The pain may be reproduced by doing single leg squat.
Predisposing factors
•Foot and knee malalignment (foot pronation &varus knee)
•Prominent lateral condyle.
•Tight IT band
•Leg length discrepancy
•Weak abductors of the hip
•Poor shoe wear
•Training errors.
Provocative examinations
The Ober's test is a clinical examination test used to access tightness of the iliotibial band.
Ober’s test
•the patient should lay on the side with the affected leg up.
•the examiner will slowly abduct the leg with the knee in flexion and the hip in full extension.
•When the IT band is tight, adduction of the leg will be limited as the leg will not touch the other knee and the test is considered positive.
Noble test
•The noble test is performed by the examiner placing the knee into flexion and putting the thumb over the iliotibial band prior to its insertion into the Gerdy’s tubercle of the lateral tibia.
•With the pressure placed onto the IT band, then extend the leg.
•If pain is felt at the lateral femoral condyle with extension of the leg, then this is a positive Noble test.
Imaging
•X-rays may not be helpful.
•MRI may show edema in the area of the ITB.
Treatment
Nonoperative
•Rest and ice
•Physical therapy is very important: stretching, proprioception and improvement in neuromuscular coordination.
•Training modification
•Better shoe wear
•Consider injection (may be helpful)
Majority of patient will get better in about 4-8 weeks.
Surgery: (last resort)
•Surgical excision of the scarred, inflamed part of the iliotibial band.
•Excision of a cyst or a bursa
•z-plasty is rarely done.
Follow me on twitter:
https://twitter.com/#!/DrEbraheim_UTMC
Donate to the University of Toledo Foundation Department of Orthopaedic Surgery Endowed Chair Fund:
https://www.utfoundation.org/foundati...
Inflammation and thickening of the iliotibial band result from excessive friction as the iliotibial band slides over the lateral femoral condyle. The iliotibial band is a thick band of fascia that extends along the lateral thigh from the iliac crest to the knee. It inserts into the Gerdy’s tubercle of the tibia.
The iliotibial band is a continuation of the tensor fascia lata muscle. The tensor fascia lata muscle arises from the outer surface of the anterior iliac crest, between the tubercle of the iliac spine and inserts into the iliotibial tract. The gluteus maximus also inserts into the iliotibial band.
Function of the iliotibial band
The IT band extends, abducts and laterally rotates the hip. The IT band also contributes to lateral knee stabilization. The IT band is repeatedly shifted forward and backward across the lateral femoral condyle.
Impingement usually occurs around 30 degrees of knee flexion. There may be swelling, tenderness and crepitus over the lateral femoral condyle. The condition of ITBS around the knee most commonly occurs in runners, cyclists and other athletes undergoing exercise with repetitive knee flexion and extension. The IT band inserts into Gerdy’s tubercle. The pain is proximal to the Gerdy’s tubercle. The pain may be reproduced by doing single leg squat.
Predisposing factors
•Foot and knee malalignment (foot pronation &varus knee)
•Prominent lateral condyle.
•Tight IT band
•Leg length discrepancy
•Weak abductors of the hip
•Poor shoe wear
•Training errors.
Provocative examinations
The Ober's test is a clinical examination test used to access tightness of the iliotibial band.
Ober’s test
•the patient should lay on the side with the affected leg up.
•the examiner will slowly abduct the leg with the knee in flexion and the hip in full extension.
•When the IT band is tight, adduction of the leg will be limited as the leg will not touch the other knee and the test is considered positive.
Noble test
•The noble test is performed by the examiner placing the knee into flexion and putting the thumb over the iliotibial band prior to its insertion into the Gerdy’s tubercle of the lateral tibia.
•With the pressure placed onto the IT band, then extend the leg.
•If pain is felt at the lateral femoral condyle with extension of the leg, then this is a positive Noble test.
Imaging
•X-rays may not be helpful.
•MRI may show edema in the area of the ITB.
Treatment
Nonoperative
•Rest and ice
•Physical therapy is very important: stretching, proprioception and improvement in neuromuscular coordination.
•Training modification
•Better shoe wear
•Consider injection (may be helpful)
Majority of patient will get better in about 4-8 weeks.
Surgery: (last resort)
•Surgical excision of the scarred, inflamed part of the iliotibial band.
•Excision of a cyst or a bursa
•z-plasty is rarely done.
Follow me on twitter:
https://twitter.com/#!/DrEbraheim_UTMC
Donate to the University of Toledo Foundation Department of Orthopaedic Surgery Endowed Chair Fund:
https://www.utfoundation.org/foundati...
7 سال پیش
در تاریخ 1396/07/18 منتشر شده
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