Runner’s Knee




Abstract


Runner’s knee, also known as iliotibial band friction syndrome, is a common cause of lateral knee pain. The iliotibial band is an extension of the fascia lata, which inserts at the lateral condyle of the tibia. The iliotibial band bursa lies between the iliotibial band and the lateral condyle of the femur. Runner’s knee is an overuse syndrome caused by friction injury to the iliotibial band as it rubs back and forth across the lateral epicondyle of the femur during running; this rubbing can also irritate the iliotibial bursa beneath it. If inflammation of the iliotibial band becomes chronic, calcification may occur. Impingement of the iliotibial band against the lateral femormal epicondyle may also contribute to the patient’s symptomatology.


Runner’s knee is a distinct clinical entity from iliotibial bursitis, although these two painful conditions frequently coexist. Runner’s knee occurs more commonly in patients with genu varum and planus feet, although worn-out jogging shoes have also been implicated in the development of this syndrome.




Keywords

runner’s knee, iliotibial band friction syndrome, knee pain, iliotibial band, popping knee, lateral femoral epicondyle, ports injury, diagnostic sonography, ultrasound guided injection, magnetic resonance imaging

 


ICD-10 CODE M76.899




Keywords

runner’s knee, iliotibial band friction syndrome, knee pain, iliotibial band, popping knee, lateral femoral epicondyle, ports injury, diagnostic sonography, ultrasound guided injection, magnetic resonance imaging

 


ICD-10 CODE M76.899




The Clinical Syndrome


Runner’s knee, also known as iliotibial band friction syndrome, is a common cause of lateral knee pain. The iliotibial band is an extension of the fascia lata, which inserts at the lateral condyle of the tibia. The iliotibial band bursa lies between the iliotibial band and the lateral condyle of the femur. Runner’s knee is an overuse syndrome caused by friction injury to the iliotibial band as it rubs back and forth across the lateral epicondyle of the femur during running ( Fig. 111.1 ); this rubbing can also irritate the iliotibial bursa beneath it. If inflammation of the iliotibial band becomes chronic, calcification may occur. Impingement of the iliotibial band against the lateral femoral epicondyle may also contribute to the patient’s symptomatology ( Fig. 111.2 ).




FIG 111.1


Runner’s knee is an overuse syndrome caused by friction injury to the iliotibial band as it rubs back and forth across the lateral epicondyle of the femur.

(From Waldman SD. Atlas of pain management injection techniques. 2nd ed. Philadelphia: Saunders; 2000:476.)



FIG 111.2


Friction and impingement model. ITB, iliotibial band; LFE, lateral femoral epicondyle.

(From Baker RL, Fredericson M. Iliotibial band syndrome in runners: biomechanical implications and exercise interventions. Phys Med Rehabil Clin N Am . 2016;27(1):53–77.)


Runner’s knee is a distinct clinical entity from iliotibial bursitis, although these two painful conditions frequently coexist. Runner’s knee occurs more commonly in patients with genu varum and planus feet, although worn-out jogging shoes have also been implicated in the development of this syndrome.




Signs and Symptoms


Patients with runner’s knee present with pain over the lateral side of the distal femur just over the lateral femoral epicondyle. Compared with iliotibial bursitis, the pain tends to be a little less localized, and effusion is rare. The onset of runner’s knee frequently occurs after long-distance biking or jogging in worn-out shoes that lack proper cushioning ( Fig. 111.3 ). Activity, especially that involving resisted abduction and passive adduction of the lower extremity, makes the pain worse, whereas rest and heat provide some relief. Flexion of the affected knee reproduces the pain in many patients with runner’s knee. Often, patients are unable to kneel or walk down stairs. The pain is constant and is characterized as aching; it may interfere with sleep. Coexistent bursitis, tendinitis, arthritis, or internal derangement of the knee may confuse the clinical picture after trauma to the knee.




FIG 111.3


Patients with runner’s knee present with pain over the lateral side of the distal femur, just over the lateral femoral epicondyle. The condition is often associated with running or jogging in worn-out shoes.


Physical examination may reveal point tenderness over the lateral epicondyle of the femur just above the tendinous insertion of the iliotibial band (see Fig. 111.1 ). If iliotibial bursitis is also present, the patient may have swelling and fluid accumulation around the bursa. Palpation of this area while the patient flexes and extends the knee may result in a creaking or “catching” sensation. Active resisted abduction of the lower extremity reproduces the pain, as does passive adduction. Sudden release of resistance during this maneuver causes a marked increase in pain. Pain is exacerbated when the patient stands with all his or her weight on the affected extremity and then flexes the affected knee 30 to 40 degrees.

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Sep 9, 2019 | Posted by in PAIN MEDICINE | Comments Off on Runner’s Knee

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