0:00

Now let's talk about the first pathologic entity you might

0:03

encounter at the iliotibial ban.

0:05

And that is iliotibial ban syndrome.

0:08

And some people insert the word friction

0:10

between ITB and syndrome.

0:12

And because this is thought to be related to

0:15

repetitive chronic motion

0:16

or rubbing of the ITB over the lateral femoral epicondyle.

0:22

And this may be accompanied by a bursitis

0:25

and this is a point of contention

0:27

'cause there are some people who believe

0:28

that there is a physiologic bursa that lives deep

0:32

to ILI band, while others think

0:34

that if you do develop a bursa it's more of a adventitious

0:38

or acquired versa.

0:39

But certainly on MR Imaging, we can see the presence

0:42

of fluid collections in this area.

0:44

And we know that the space is narrowest at approximately 30

0:47

degrees of flexion.

0:49

So this is why a lot

0:50

of people think it's the chronic flexion

0:52

and extension of the knee and rubbing back

0:53

and forth of the ITB over the lateral epicondyle

0:56

that results in the syndrome.

0:59

So what do we see on MRI?

1:01

We'll typically see soft tissue edema deep

1:04

to the iliotibial band at the level

1:06

of the lateral epicondyle.

1:08

It's important to separate this from

1:10

fluid within the joint space.

1:12

You can often see the thin joint capsule terminating about

1:16

the mid portion of the lateral fal condyle if you go from

1:19

the trochlea, uh, in the front

1:21

to the epicondyle in the back.

1:23

So this is your typical appearance

1:25

of iliotibial band friction syndrome.

1:27

This one just happens to be in a runner who, uh,

1:31

responded well to steroid injection into, to the, uh,

1:35

soft tissues, deep to the illit tibial band.

1:38

Here's an example of an older patient there.

1:41

They actually came for concern for lateral meniscus tear.

1:44

We did not find a lateral meniscus tear

1:46

or other significant p pathology in the lateral compartment.

1:50

So when I don't really find anything, then my next place

1:54

that I'll look at is the Ileal Tubial band

1:56

and see if there's any findings

1:57

to suggest friction syndrome.

1:59

And here you can see

2:01

that there is indeed a fluid collection adjacent

2:04

to the lateral epicondyle and deep to the IAL tubule band.

2:07

You'll also notice another fiber structure,

2:09

which we'll talk about later, and Dr.

2:12

Resnick has already told you about in a previous lecture.

2:14

But if we look at the corresponding axial images too, again,

2:18

we can see the posterior extent of the joint recess,

2:21

that super patellar pouch.

2:23

And as we scroll down, up

2:24

and down, we can see this separate

2:26

bursa or fluid collection.

2:28

Again, this may inflammation of a native bursa

2:31

or possibly an average fictitious bursa.

2:37

There was a study, um, uh, now a long time ago,

2:40

almost 20 years ago, that looked at the anatomy

2:44

and histology of the ILO tibial band.

2:47

And they found that the, there were some fibrous extensions

2:49

from the deep surface of the ILO tibial band

2:52

that basically anchored it to the periphery

2:55

of the lateral femoral condyle.

2:57

And they found in this tissue that

2:58

It was composed of fiber fatty tissue

3:01

with some blood vessels as well as these, um, structures,

3:04

which you may recognize from your medical school histology

3:07

days as a Pacinian Corp vessel, which is important

3:11

for vibratory sensation.

3:14

So, uh, according to this, um, research, they found

3:19

that movement of the IT band was more in a medial

3:22

to lateral dimension, la lateral direction, uh,

3:25

rather than a front to back, uh, direction.

3:29

So they suggested that maybe a little tibial band, uh,

3:32

friction syndrome is more of a side

3:34

to side compression rather than a front to back, um,

3:38

pain syndrome.