OrthoNow/Upstate Orthopedics Provides Injury Information

April 11, 2012 at 8:26 AM

34.jpgOrthoNow is the presenting sponsor of the 2012 Mountain Goat Training Runs and will be offering advice and explanations on various running injuries leading up to the Mountain Goat Run.

This week's information was put together by Dr. Josh Pletka, Orthopedic Surgeon/Upstate Orthopedics and addresses Iliotibial Band Syndrome.

What is Iliotibial Band Syndrome?

Iliotibial band syndrome (ITBS) is inflammation and irritation of the iliotibial band, a thick band of fibrous tissue on the outside of the thigh and knee.

What is the function of the Iliotibial Band?

The band functions in coordination with several of the thigh muscles to provide stability to the outside of the knee joint. It also assists with flexion of the knee joint.

How do I know if I have ITBS?

When irritated, movement of the knee joint becomes painful. Usually the pain worsens with continued movement, and resolves with rest.

Common symptoms of ITBS include:

Pain over the outside of the knee joint, swelling at the location of discomfort, and snapping or popping sensation as the knee is bent.

Who is at risk for developing ITBS? 

Endurance athletes are especially prone to developing iliotibial band syndrome. Athletes who suddenly increase their level of activity, such as runners who increase their mileage, often develop iliotibial band syndrome.

How is Iliotibial Band Syndrome diagnosed?

For Orthopedic Surgeons, ITBS is a clinical diagnosis using information from the patient's history and physical exam. Usually imaging studies such as MRIs and CT scans are unnecessary to make the diagnosis.

Can anything else cause pain on the outside of the knee and thigh?

Yes. The differential diagnosis for lateral (outside) knee pain is:

  • Biceps femoris tendinopathy
  • Degenerative joint disease
  • Lateral collateral ligament sprain
  • Lateral meniscal tear
  • Myofascial pain
  • Patellofemoral stress syndrome
  • Popliteal tendinopathy
  • Referred pain from lumbar spine
  • Stress fracture
  • Superior tibiofibular joint sprain

How is Iliotibial Band Syndrome treated?

Treatment requires activity modification, massage, and stretching and strengthening of the affected limb. The goal is to minimize the friction of the iliotibial band as it slides over the femoral condyle. The patient may be referred to a physical therapist that is trained in treating iliotibial band syndrome. Most runners with low mileage respond to a regimen of anti-inflammatory medicines and stretching; however, competitive or high-mileage runners may need a more comprehensive treatment program.

What happens my ITBS doesn't improve?

A cortisone injection into the area of inflammation may also be attempted, usually after these other treatments fail. If all else fails to relieve the discomfort of ITBS, surgery is an option, but only in very rare circumstances.

I had this pain before and it got better after a steroid injection - can I have another one?

Yes, but... There is no rule as to how many cortisone injections can be given. Often physicians do not want to give more than three, but there is not really a specific limit to the number of shots. However, there are some practical limitations. If a cortisone injection wears off quickly or does not help the problem, then repeating it may not be worthwhile. Also, animal studies have shown effects of weakening of tendons and softening of cartilage with cortisone injections. Repeated cortisone injections multiply these effects and increase the risk of potential problems. This is the reason many physicians limit the number of injections they offer to a patient.

It has been 6 months and nothing has worked - do I need surgery?

Surgery is rarely indicated; after 6 to 12 months of continuous symptoms that do not respond to non-operative measures, surgery can be considered. The most common procedure for ITBS is resection of the posterior portion of the iliotibial band (ITB) and, if desired, the adventitial bursa deep to the band. Surgery is performed with the knee held in 30° of flexion and consists of a limited resection of a small triangular or elliptical piece of the posterior part of the ITB covering the lateral femoral epicondyle. The bursa may be removed in certain cases as well.

My ITBS went away with treatment but now is back, what should I do?

Start the routine over again, as soon as possible - including a period of rest, NSAIDs, and potentially physical therapy. Even after ITBS resolves, it is wise to continue at least the stretching and massage exercises, which can be done at home without the help of a therapist.


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