Sonography of the iliotibial band: spectrum of findings

Iliotibial band lesions constitute a potential source of discomfort and are frequently confounded with other conditions which cause pain on the lateral aspect of the hip, thigh and knee. Ultrasonography is usually regarded as a first-line imaging modality in the assessment of such conditions because of its excellent diagnostic accuracy, low cost and wide availability. The correct identification of the structure involved in the production of symptoms leads to an appropriate management and to a higher probability of resolution of the clinical complaint. The present article is aimed at reviewing the different sonographic presentations of iliotibial band syndromes.

Sonography; Iliotibial band; Iliotibial band friction syndrome

Authorship

Carlos Frederico Arend

MD, Radiologist, Radimagem - Diagnóstico por Imagem, Porto Alegre, RS, BrazilMD, Radiologist, Radimagem - Diagnóstico por Imagem, Porto Alegre, RS, BrazilBrazilPorto Alegre, RS, BrazilMD, Radiologist, Radimagem - Diagnóstico por Imagem, Porto Alegre, RS, Brazil

Mailing Address: Dr. Carlos Frederico Arend. Avenida Cristóvão Colombo, 1691, Floresta. Porto Alegre, RS, Brazil, 90560-001. E-mail: carlos_arend@hotmail.com

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (8)

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Figure 1.
Proximal iliotibial band syndrome . Female, 27-year-old patient, professional athlete, presenting with focal pain adjacent to the right iliac crest that intensifies during physical activity. Longitudinal image acquired with a 5-13 MHz linear transducer demonstrating thickening and hypoechogenicity of the iliotibial band origin (arrow heads) adjacent to the iliac tubercle (it).

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Figure 2.
Snapping hip syndrome . Male, 16-year-old, asymptomatic patient referred by his mother for assessment due to chronic snapping in the peritrochanteric region. A: Transverse image acquired with a 5-13 MHz linear transducer, with extended thigh, demonstrates the iliotibial band, the gluteus medius (gm) and the greater trochanter (Gt). Note the posterior edge of iliotibial band located posteriorly to the trochanter. B: With progressive flexion of the thigh, there is a sudden anterior migration of the band and emergence of the gluteus maximus (gM) on the evaluation plane. The arrow indicates the direction of the iliotibial band displacement.

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Figure 3.
Early stage of iliotibial band syndrome . Male, 37-year-old patient, amateur cyclist, presenting with pain in the lateral aspect of his knee that intensifies during physical activity. Longitudinal image acquired with a 5-13 MHz linear transducer demonstrating increased echogenicity of the fat tissue (arrow head) interposed between the iliotibial band (itb) and the femur (fem). tib, tibia.

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Figure 4.
Iliotibial band syndrome . Male, 42-year-old patient, recreational marathoner, presents with intermittent pain in the lateral aspect of his knee, proximally to the joint line. A: Longitudinal image acquired with a 5-13 MHz linear transducer, with extended knee, demonstrates adventitious bursitis in a typical location (asterisks), interposed between the normal iliotibial band (arrow heads) and the lateral femoral (fem) condyle. B: Magnetic resonance imaging - coronal, STIR sequence confirming the sonographic findings. At magnetic resonance imaging, the iliotibial band is identified as an elongated structure with low signal intensity on T1- and T2-weighted sequences, while the neobursa presents a fluid intensity signal. tib, tibia.

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Figure 5.
Iliotibial band syndrome . Male, 47-year-old patients, recreational marathoner, with constant pain in the lateral aspect of the knee. A: Transverse image acquired with a 5-13 MHz linear transducer, at the level of the lateral femoral (fem) condyle, with extended knee, demonstrating typical adventitious bursitis (asterisks) deeply located in the normal iliotibial band (arrow heads). B: Compressive study demonstrating bursal walls apposition which may generate false-negative results.

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Figure 6.
Iliotibial band syndrome . Male, 57-year-old, amateur cyclist, reporting chronic, intermittent pain in the lateral aspect of the knee. A: Longitudinal image acquired with a 5-13 MHz linear transducer, demonstrating thickening and hypoechogenicity of the iliotibial band (asterisk) at the level of the lateral femoral (fem) condyle. Also, observe the normal distal band (arrow heads) inserting into the tibia tibia (tib). B: Comparative contralateral image demonstrating the normality along the entire course of the iliotibial band (arrow heads).

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Figure 7.
Insertional iliotibial band tendinosis . Male, 89-year-old, sedentary patient, presents with pain epicenter in the lateral aspect of his knee, with proximal irradiation, with no apparent motive. Longitudinal image acquired with a 5-13 MHz linear transducer, demonstrating juxtainsertional thickening and hypoechogenicity of the iliotibial band (arrow heads) adjacent to the tibia (tib).

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Figure 8.
Iliotibial band as a catalyst of peritrochanteric syndrome . Female, 69-year-old, sedentary patient, presenting with chronic peritrochanteric pain. A: Transverse image acquired with a 5-13 MHz linear transducer demonstrating thickening of the iliotibial band (arrow heads), as well as signs of gluteus medius (gm) tendinosis adjacent to its insertion into the greater trochanter of the femur (Gt).

Figure 1. Proximal iliotibial band syndrome . Female, 27-year-old patient, professional athlete, presenting with focal pain adjacent to the right iliac crest that intensifies during physical activity. Longitudinal image acquired with a 5-13 MHz linear transducer demonstrating thickening and hypoechogenicity of the iliotibial band origin (arrow heads) adjacent to the iliac tubercle (it).

Figure 2. Snapping hip syndrome . Male, 16-year-old, asymptomatic patient referred by his mother for assessment due to chronic snapping in the peritrochanteric region. A: Transverse image acquired with a 5-13 MHz linear transducer, with extended thigh, demonstrates the iliotibial band, the gluteus medius (gm) and the greater trochanter (Gt). Note the posterior edge of iliotibial band located posteriorly to the trochanter. B: With progressive flexion of the thigh, there is a sudden anterior migration of the band and emergence of the gluteus maximus (gM) on the evaluation plane. The arrow indicates the direction of the iliotibial band displacement.

Figure 3. Early stage of iliotibial band syndrome . Male, 37-year-old patient, amateur cyclist, presenting with pain in the lateral aspect of his knee that intensifies during physical activity. Longitudinal image acquired with a 5-13 MHz linear transducer demonstrating increased echogenicity of the fat tissue (arrow head) interposed between the iliotibial band (itb) and the femur (fem). tib, tibia.

Figure 4. Iliotibial band syndrome . Male, 42-year-old patient, recreational marathoner, presents with intermittent pain in the lateral aspect of his knee, proximally to the joint line. A: Longitudinal image acquired with a 5-13 MHz linear transducer, with extended knee, demonstrates adventitious bursitis in a typical location (asterisks), interposed between the normal iliotibial band (arrow heads) and the lateral femoral (fem) condyle. B: Magnetic resonance imaging - coronal, STIR sequence confirming the sonographic findings. At magnetic resonance imaging, the iliotibial band is identified as an elongated structure with low signal intensity on T1- and T2-weighted sequences, while the neobursa presents a fluid intensity signal. tib, tibia.

Figure 5. Iliotibial band syndrome . Male, 47-year-old patients, recreational marathoner, with constant pain in the lateral aspect of the knee. A: Transverse image acquired with a 5-13 MHz linear transducer, at the level of the lateral femoral (fem) condyle, with extended knee, demonstrating typical adventitious bursitis (asterisks) deeply located in the normal iliotibial band (arrow heads). B: Compressive study demonstrating bursal walls apposition which may generate false-negative results.

Figure 6. Iliotibial band syndrome . Male, 57-year-old, amateur cyclist, reporting chronic, intermittent pain in the lateral aspect of the knee. A: Longitudinal image acquired with a 5-13 MHz linear transducer, demonstrating thickening and hypoechogenicity of the iliotibial band (asterisk) at the level of the lateral femoral (fem) condyle. Also, observe the normal distal band (arrow heads) inserting into the tibia tibia (tib). B: Comparative contralateral image demonstrating the normality along the entire course of the iliotibial band (arrow heads).

Figure 7. Insertional iliotibial band tendinosis . Male, 89-year-old, sedentary patient, presents with pain epicenter in the lateral aspect of his knee, with proximal irradiation, with no apparent motive. Longitudinal image acquired with a 5-13 MHz linear transducer, demonstrating juxtainsertional thickening and hypoechogenicity of the iliotibial band (arrow heads) adjacent to the tibia (tib).

Figure 8. Iliotibial band as a catalyst of peritrochanteric syndrome . Female, 69-year-old, sedentary patient, presenting with chronic peritrochanteric pain. A: Transverse image acquired with a 5-13 MHz linear transducer demonstrating thickening of the iliotibial band (arrow heads), as well as signs of gluteus medius (gm) tendinosis adjacent to its insertion into the greater trochanter of the femur (Gt).

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