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Condition/Disorder Synonyms

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  • Runner's knee1

  • Tensor fascia latae syndrome (TFLS)

  • Iliotibial band friction syndrome (ITBFS)

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ICD-9-CM Code

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  • 728.89 Other disorders of muscle, ligament, and fascia

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ICD-10-CM Code

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  • M62.89 Other specified disorders of muscle

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Preferred Practice Pattern

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Key Features

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Description

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  • Original presumed model of repetitive stress injury due to friction between the IT band3 and lateral femoral condyle, occurring at approximately 30 degrees of knee flexion4

    • Inflammation begins at IT band's insertion and where friction develops between the IT band and lateral femoral condyle1

  • Newer proposed model of the ITB being a thickness within the lateral fascia

    • Tightening is a result of repetitive stress

    • Lateral extension of the synovial capsule in the knee, lateral synovial recess

    • Cyst formation

    • Osseous edema without evidence of fascial inflammation

    • Bursitis that develops deep within the IT band as it crosses the lateral femoral condyle3

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Essentials of Diagnosis

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  • Diagnosis usually made by clinical examination

  • Progression of symptoms often associated with changes in training practice (e.g., increased running mileage or change in training surfaces, especially downhill running1)

  • Pain from ITBFS so severe that activity must be discontinued

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General Considerations

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  • Most commonly occurs from overuse injury of the knee, especially in long-distance runners

  • Frequently develops in people with inadequate warm-up or stretching program before exercise

  • Associated with leg-length discrepancies, tensor fascia latae contractures, excessive pronation, tight heel cords1, 6

  • Though most common in runners, may occur with any activity requiring constant knee flexion and extension1

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Demographics

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  • Men and women equally affected

  • Distance runners, exacerbated with downhill running

  • Cyclists

  • Repetitive knee flexion, extension

  • Training on uneven terrain or graded slopes

  • Change in Q-angle as a result of leg-length discrepancy4

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Clinical Findings

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Signs and Symptoms

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  • Localized tenderness and pain along lateral aspect of knee, especially with repetitive knee motion

  • Pain may be diffuse and general at onset, becoming more specific and intense as ITBFS progresses

    • Specific pain localized approximately 2 cm above joint line over the lateral femoral condyle with knee flexed 30 degrees3

    • Pain will radiate to lateral joint line and distally to proximal tibia1

  • Pain typically begins after completion of activity, but may occur during activity or periods of rest as condition progresses7

  • Crepitus upon palpation over lateral condyle3

  • Specific swelling over lateral condyle3

  • Increased pain after long periods of sitting4

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Functional Implications

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  • Pain with running (especially on downhill terrain) and cycling

  • Pain with walking and other activities that ...

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