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Case 101

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A 25-year-old otherwise healthy male patient complains of right lateral knee pain for two weeks. He is a regular runner and reports having increased his training intensity during the last month. He denies any kind of trauma or injuries at the time of symptoms onset. No walking abnormalities or mechanical axis deviation are observed. On palpation, there is tenderness over the lateral femoral epicondyle at 30 degrees of knee flexion. There is no joint effusion.

Based on the images and clinical history, which is the most likely diagnosis?

a) Lateral collateral ligament injury

25%

b) Lateral meniscus injury

25%

c) Iliotibial band syndrome

25%

d) Tibial stress fracture

25%
   

Comments

- The iliotibial tract (ITB) is a thick band of the lateral aspect of the fascia lata, which, among other functions, aids in the stabilization of the knee joint.

-  The iliotibial band syndrome (ITBS) is the most common cause of lateral knee pain among athletes and affects especially runners.

- The ITBS consists of the inflammation of the distal portion of the ITB and results from the repetitive knee flexion.

- Although the diagnosis is clinical, radiography and magnetic resonance imaging (MRI) of the knee might be helpful in some cases. Edema of the tissue adjacent to the ITB is observed in the MRI.

- Treatment includes rest, ice and anti-inflammatory medication; after pain relief, physiotherapy is recommended.

References

- Stauss EJ, Kim S, Calcei JG, Park D. Iliotibial Band Syndrome: Evaluation and Management. Journal of the American Academy of Orthopaedic Surgeons. 2011 Dec; 19: 728-736.

- Novais, Eduardo Nilo Vasconcelos; Carvalho Junior, Lúcio Honório de. Fundamentos de Ortopedia e traumatologia. Belo Horizonte: COOPMED, 2009. 586p.

- Hergenroede, Albert C. Traumatic causes of acute knee pain and injury in the young athlete. Basow DS, editor. Waltham (MA): Uptodate; 2012. Available at: http://www.uptodate.com/contents/traumatic-causes-of-acute-knee-pai

Authors

Juliana da Cunha Pimentel Ulhôa - 5th year medical student of UFMG School of Medicine. E-mail: ju_ulhoa[at]hotmail.com

Luanna da Silva Monteiro - 4th year medical student of UFMG School of Medicine. E-mail: luannasmonteiro[at]gmail.com

Supervisor

Dr. Lucas de Castro Boechat. Specialist in Orthopedics and Traumatology. Team member of Orthopedics, HC-UFMG and Biocor Institute.

E-mail: lboechat[at]hotmail.com

Reviewers

Emília Valle, Fernanda Foureaux and Professor Viviane Parisotto

Commentics

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