Тізе буынының іліотибиалды жолақтың зақымдануы

injury of the iliotibial band

Iliotibial band syndrome (ITBS) is the second most common knee injury, and is caused by inflammation located on the lateral aspect of the knee due to friction between the iliotibial band and the lateral epicondyle of the femur. Pain is felt most commonly on the lateral aspect of the knee and is most intensive at 30 degrees of knee flexion. Risk factors seen in men are increased hip internal rotation and knee adduction.

ITBS symptoms range from a stinging sensation just above the knee and outside of the knee (lateral side of the knee) joint, to swelling or thickening of the tissue in the area where the band moves over the femur. The stinging sensation just above the knee joint is felt on the outside of the knee or along the entire length of the iliotibial band. At initial symptom onset pain typically occurs following activity, but as the condition progresses pain is frequently felt during activities and may be present at rest. Pain is frequently worsened by running up or downhill or by stride lengthening.

Iliotibial band syndrome is one of the leading causes of lateral knee pain in runners. The iliotibial band is a thick band of fascia composing the tendon of the tensor fascia latae muscle. It is located on the lateral aspect of the knee, extending from the outside of the pelvis, over the hip and knee, and inserting just below the knee. The band serves to stabilizing the knee. It has been proposed that during activity such as running and cycling the iliotibial band slides back and forth over the lateral femoral epicondyle, which causes friction and inflammation of the band. Additional proposed mechanisms causing the symptoms of ITBS include compression of the fat and soft tissues beneath the iliotibial band, and chronic iliotibial band bursitis.

Other conditions that may present with knee pain similar to ITBS that must be differentiated include a lateral meniscus tear, degerative joint disease, tendinopathy of the biceps femoris, stress fracture, patellofemoral pain syndrome, and injury to the lateral collateral ligament.

Imaging studies are generally not needed for diagnosis of ITBS, as characteristic symptoms and physical exam findings are sufficient for diagnosis. However, in severe or persistent cases MRI may be used to confirm the diagnosis as well as rule out other causes of lateral knee pain. Ultrasonography may also be used to evaluate disease progression by measuring iliotibial band thickness. Utilization of corticosteroid injections and the use of oral nonsteroidal anti inflammatory drugs (NSAIDs) or topical NSAIDs on the painful area are possible treatments for ITB syndrome. Corticosteroid injections have been shown to decrease running pains significantly 7 days after the initial treatment. Similar results can be found with the use of anti inflammatory medication, analgesic/anti inflammatory medication, specifically. Muscular training of the gluteus maximus and hip external rotators is stressed highly as those muscles are associated with many of the risk factors of ITBS. Complications of ITBS include recurrence and exacerbation by return to activity following treatment, as well as possible progression to patellofemoral pain syndrome. The relationship between ITBS and mortality/morbidity is claimed to be absent. A study showed that coordination variability did not vary significantly between runners with no injury and runners with ITBS. This result elucidates that the runner's ability to coordinate themselves toward direction of their intention (motor coordination) is not, or very minorly affected by the pain of ITBS. Additionally, military trainee in marine boot camps displayed high incidence rate of ITBS. Varying incidence rate of 5.3–22% in basic training was reported in a case study. A report from the U. S. Marine Corps announces that running/overuse related injuries accounted for >12% of all injuries. Studies suggest that there is not a difference in ITBS incidence rate between patients of different race, gender, or age. However, there has been a claim that females are more prone to ITBS due to their anatomical differences in the pelvis and lower extremities. Males with a larger lateral epicondyle prominence may also be more susceptible to ITBS. Higher incidence rate of ITBS has been reported between the ages of 15 and 50, which generally includes most active athletes. Other professions that had noticeable association with ITBS include cyclists, heavy weightlifters, et cetera. One observational study discovered 24% of 254 cyclists were diagnosed with ITBS within 6 years. A study provided data that shows more than half (50%) of professional cyclists complain of knee pain. Additional studies have shown that ITBS makes up 15 24% of all overuse injuries in cyclists.

ITBS was originally described by Lieutenant Commander James W. Renne in 1975 after observing frequent lateral knee pain in recruits participating in intensive military training. He initially named the syndrome iliotibial band friction syndrome.