EpistemisIliotibial band syndrome
Specialty: Musculoskeletal.
Why it occurs
- Repeated friction of the iliotibial band on the lateral femoral epicondyle during knee flexion and extension (around 30° of flexion)
- Repetitive practice of long-distance running or cycling without adaptation periods
- Altered biomechanics of the lower extremity (genu varus, excessive pronation of the foot)
- Weakness of the hip abductors (mainly the gluteus medius muscle)
- Running on inclined terrain or surfaces with steep slopes
Initial workup
Positive Noble clinical test and Ober test on physical examination | Ultrasound of the lateral aspect of the knee (shows thickening of the iliotibial band > 3 mm at the level of the epicondyle and fluid collection deep to the band) | Magnetic resonance imaging of the knee if it is necessary to rule out a tear of the external meniscus.
red flags
Acute lateral knee pain accompanied by fluctuating local swelling, intense heat, local erythema, and fever (suggests bursitis of the lateral femoral epicondyle of septic origin).
Standard management
- Ketoprofen — 100 mg every 12 hours orally for 5-7 days; systemic anti-inflammatory
- Diclofenac gel 1.16% — apply locally every 8 hours on the lateral femoral epicondyle
- Perilesional infiltration (never intratendinous) of methylprednisolone (20 mg with 1% lidocaine) into the deep space of the band if limiting pain persists.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Musculoskeletal
- Listed causes
- 5
- Treatment options
- 3