| October 2005 Case of the Month |
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Compiled By: James Joseph, M.D.
History: 48 year old weightlifter with knee pain.
Examination: MRI of the Knee. Coronal PD Fat Sat, Axial T2.
Findings: Increased T2 (and PD) signal consistent edema and inflammation are present surrounding the iliotibial band which is thickened.
Diagnosis: Iliotibial Band Friction Syndrome.
Discussion: Iliotibial Band Friction Syndrome is a common overuse injury occurring in athletes. It is the most common cause of lateral knee pain in long distance runners and cyclists, and is also seen in athletes involved in football, soccer, tennis and weightlifting. The iliotibial band is a thickening of the fascia of the lateral thigh that inserts on the lateral aspect of the tibia at Gerdy’s tubercle. Repetitive knee flexion and extension result in frictional trauma as the iliotibial band rubs against the lateral femoral condyle.
Magnetic resonance imaging demonstrates T2 hyperintense edema and inflammation deep to or surrounding the iliotibial band within the lateral aspect of the knee. Alteration of the caliber of the iliotibial band with thickening or focal thinning may occur. A focal fluid collection deep to the iliotibial band may be found. This represents an adventitial bursa or less likely inflammation within a primary bursa or the lateral recess of the knee.
Initial treatment is conservative and includes stretching, rest, ice, and anti-inflammatory medication. Orthotic devices can be used to correct abnormal biomechanics and decrease frictional trauma. Steroid injections may be given. Only rarely is surgery required.
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References:
- Pomeranz J, Stephen. Gamuts & Pearls in MRI and Orthopaedics. MRI-EFI Publishing, Cincinnati, OH. 1997. p.175.
- Muhle C, Joong MA, LeeRen Y et. al. Iliotibial Band Friction Syndrome: MR Imaging Findings in 16 Patients and MR Arthrographic Study in Six Cadaveric Knees. Radiology. 1999; 212: 103-110.
- Stoller DW, Tirman TJ, Bredella MA. Diagnostic Imaging Orthopaedics. Amirsys Inc. Salt Lake City, UT. 2004.
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