CASE 16196 Published on 29.10.2018

Iliotibial band syndrome

Section

Musculoskeletal system

Case Type

Clinical Cases

Authors

Luís Amaral Ferreira, Inês Abreu, João Filipe Costa

Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
Patient

26 years, male

Categories
Area of Interest Musculoskeletal soft tissue, Musculoskeletal joint ; Imaging Technique MR
Clinical History
A 26 year old male patient, previously healthy with a sedentary life, presented with lateral left knee pain after two weeks of intensive walking. On physical examination the patient presented with tenderness over the lateral femoral condyle and pain while flexing the knee. Remaining physical examination was unremarkable.
Imaging Findings
Magnetic resonance of the left knee was performed. The fatty soft tissues surrounding the iliotibial band, mainly between the iliotibial band and the lateral femoral condyle, present high signal on Proton Density (PD) with fat suppression (figure 1a and 2) and low signal on T1 weighted images (figure 1b) due to edema. There is also articular effusion (figure 3). There were no other signal or morphological alterations in the remaining knee structures.
Discussion
Iliotibial band syndrome results from the repetitive friction of the iliotibial band as it slides over the lateral femoral condyle, moving anterior to the condyle during knee extension and posterior region during knee flexion, remaining tense at both positions [1, 2, 3].

Iliotibial band syndrome is a common cause of lateral knee pain, related to intense practice of physical exercise, mainly in long distance runners and cyclists. It is the most common running injury of the lateral knee with a incidence of 1,6 to 12%, while in cycling accounts for 15 to 24% of overuse injuries [2].

The diagnosis of iliotibial band syndrome is essentially clinical, however MRI may be useful for diagnosis and to make the differential of lateral knee pain such as lateral meniscal rupture or lateral collateral ligament injury. MRI findings include ill defined signal changes in fatty soft tissue that lies between the iliotibial band and the lateral condyle of the femur, namely T1 low signal and T2 high signal due to edema and/or fluid [2, 3].
When long standing friction is maintained, thickening of the iliotibial band and T2 high signal may be identified in superficial tissues.

Initial treatment for iliotibial band syndrome is conservative with physical therapy, oral anti-inflammatory medication and eventually steroid injections [2]. For those not responding to conservative treatment there is a surgical option which consists in resection of the posterior aspect of the iliotibial band.

Written informed patient consent for publication has been obtained.
Differential Diagnosis List
Iliotibial band syndrome
Lateral meniscal tear
Lateral collateral ligament injury
Final Diagnosis
Iliotibial band syndrome
Case information
URL: https://eurorad.org/case/16196
DOI: 10.1594/EURORAD/CASE.16196
ISSN: 1563-4086
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