ITB Friction Syndrome

Pathology

 

ITB rubbing on LFC

- long distance runners (slow running more at risk than fast)

- cyclists (seat too high, improper technique)

 

ITB becomes tight, especially posterior portion

 

Develop inflammed tissue under ITB

- synovium

- bursa

 

Aetiology

 

Overuse 

- sudden increase in distance

- hill running

- genu varum 

- improper shoe wear

 

Examination

 

Point tenderness

 

Ober Test 

- unaffected knee and hip at 90o

- abduct hip, flex knee

- if ITB tight, unable to drop below horizontal

 

Investigations

 

Xray / MRI

- exclude other diagnosis

- stress fractures

- ganglion

 

MRI

 

Nishimura et al Skeletal Radiol 1997

- swelling and oedema behind ITB

- usually the posterior portion

- no evidence of thickening of ITB

 

Non operative

 

Physiotherapy

 

NSAID / HCLA injections

- settle the acute phase

- allow aggressive ITB stretching

 

Operative

 

Options

 

1.  Local excision of ellipse / portion of ITB that is catching

2.  ITB lengthening

3.  Excision ITB bursa

 

Results

 

Hariri et al Am J Sports Med 2009

- 11 ITB bursectomies followed up for 20 months

- 9/11 completely or mostly satisfied