Review Question - QID 217836

Iliotibial (IT) band syndrome is caused by repetitive irritation at the lateral femoral condyle and can be confirmed on physical examination with a positive Ober test.

IT band syndrome is a common overuse injury seen frequently in cyclists and runners and is caused by repetitive knee flexion and extension. The IT band originates as a continuation of the tensor fascia lata and inserts at Gerdy's tubercle on the tibia as seen in Figure A. During repetitive knee flexion and extension the IT band is thought to shift anteriorly and posteriorly over the lateral femoral condyle, causing irritation of the surrounding structures. Pain is usually localized over the lateral femoral condyle, but can also be insertional at Gerdy's tubercle. Symptoms can be provoked on physical examination with Ober's test, which is positive when pain or clicking are detected with the hip brought from flexion/abduction into extension/adduction with the patient side-lying (Illustration A). IT band syndrome is usually treated with a combination of rest, NSAIDS, physical therapy, and activity modifications.

Vieira et al. performed a structural review of the anatomy of the IT band, noting its origin, insertions, and layers. They noted it has superficial, deep, and capsular-osseous layers and connections throughout its course to the femur, patella, and tibia. They discuss the IT band functions as an anterolateral knee stabilizer and plays an important role in cases of knee instability.

Flato et al. reviewed the IT band in detail, including imaging, anatomy and other pathology. They review the different points of structural pathology that can occur with the IT band including proximal IT band syndrome, insertional tendinosis and avulsion fractures at Gerdy's tubercle. They go on to discuss the clinical management and decision making of each of these pathologies.

Figure A demonstrates the tibial insertion of the iliotibial band at Gerdy's tubercle, marked by the red circle. Illustration A indicates the positioning for Ober's test.

Incorrect Answers:
Answer 2: A positive McMurray's test indicates meniscal injury, evidenced by popping or clicking when the leg is brought from a flexed to an extended position in combination with tibial rotation.
Answer 3: Laxity and pain at 30º flexion with a varus stress would indicate isolated LCL injury. The LCL attaches on the anterior fibula, rather than Gerdy's tubercle.
Answer 4: The Dial test indicates isolated posterolateral corner injury with asymmetry >10º in external rotation at 30º knee flexion. The posterolateral corner consists of the LCL, popliteus, and popliteofibular ligaments.
Answer 5: A pivot shift test is indicative of an ACL rupture, with a "clunk," felt when the knee is brought from an extended position to a flexed position with the leg internally rotated and placed in a position of valgus stress. The "clunk," is caused by the reduction of the tibial plateau around 20-30º of knee flexion.