Cheatography
https://cheatography.com
Presentation, management etc
This is a draft cheat sheet. It is a work in progress and is not finished yet.
Causes
- Overuse/tight ITB |
- Runners and cyclists more susceptible |
- Compression of fat pad between ITB and epicondyle |
- Traction periostitis/enthesopathy from tensile strain on femoral attachment of distal ITB |
Demographics/Risk factors
- Repetitive knee flexion and extension while in single leg stance |
- Runners, Cycling, weight lifting, skiing, soccer, basketball, field hockey, competitive rowing |
- TFL Hypertonicity |
- High mileage running |
- Running on circular track (shortens ITB) |
- Weak/fatigued hip abductors - alllows excessive adduction of the thigh and int rot of the knee during stance phase |
- Pes cavus (pes planus/hyperpronation of the foot unlikely cause) |
Presentation
- Sharp/burning pain (2cm superior to lateral joint line of the knee) |
- Pain can radiate slightly proximally/distally |
- Aggravated by repetitive knee flexion and extension |
- TTP over lateral femoral epicondyle |
- +ve Nobles, Obers test |
- Hypertonic psoas and TFL |
- Hip abductor weakness |
Imaging
- Usually not beneficial |
- MRI useful to rule out other diagnosis/unresponsive to conservative care |
- Oedema present over lateral epicondyle/thickening of distal ITB |
- US |
DDx
- Lateral meniscus injury |
- OA |
- Stress f# |
- PFPS |
- LCL Sprain |
- Hamstring tendinopathy |
Management
- Strengthening of hip abductors and ext rot (clam, side bridge, posterior lunge |
- NSAIDs/Steroids |
- Massage/STW of ITB - Foam roller |
- Joint restrictions of Lx, SI, LL |
- Leg length inequality |
- Lower duration of exercise - slow paced running on flat surface |
- Minimise downhill running and avoid running on banked surfaces |
- If track work unavoidable, runners should reverse directions each mile |
- Avoid running on wet/icy surfaces - require greater TFL activation for stabilisation |
- Avoid stair climbers, squats and dead lifts |
- Cyclists may need to adjust seat height and avoid toe in pedal positions |
- Surgery considered if no better with conservative care >6 months |
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