1. ITB Ultrasound Scanning
Yin-Ting Chen, MD
MAJ, MC USA
Director, Sports/Ultrasound Clinic
Physical Medicine & Rehabilitation
WRNMMC
Boston, October 2015

2. OBJECTIVE
Anatomy of ITB and adjacent structures
ITB pathology on ultrasound
ITB Intervention
Ultrasound scanning technique

3. Anatomy of ITB

4. Anatomy ITB A thick band of fascia on the lateral aspect of the knee
Extending from the outside of the pelvis, over the hip and knee, and inserting just below the knee
Thigh flexion at the hip, abduction, and medial rotation
Stabilizes the knee laterally

5. Origin
Anterior iliac crest outer lip, anterior border of the ilium, outer surface of anterior superior iliac spine
Insertion
Superficial to vastus lateralis
Lateral epicondyle of the femur then passes in its broad expansion between lateral aspect of patella
Over lateral aspect of lateral femoral condyle
Gerdy’s tubercle
Anterior to LCL

6. Anatomy

7. Other associated structures
LCL
Origin: lateral femoral condyle
Insertion: fibular head
Superficial to lateral meniscus
Inserts to Fibula head
Posterior to ITB, superficial to popliteal tendon

8. Lateral drawing: Insertion of iliotibial band
Mid third capsular ligament
Lateral collateral ligament
Fabellofibular ligament
Popliteus muscle and tendon
Haims AH, Medvecky MJ, Pavlovich R Jr, Katz LD. MR imaging of the anatomy of and injuries to the lateral and posterolateral aspects of the knee. AJR Am J Roentgenol Mar;180(3):

9. Posterior drawing Biceps femoris tendon attachment
Lateral collateral ligament
Popliteofibular ligament
Popliteus muscle and tendon
Haims AH, Medvecky MJ, Pavlovich R Jr, Katz LD. MR imaging of the anatomy of and injuries to the lateral and posterolateral aspects of the knee. AJR Am J Roentgenol Mar;180(3):

10. ITB Scanning

11. ITB
Robust tendon, 2-3 times the thickness of the LCL
Runs in parallel to the patellar tendon
May have significant anisotropy near its insertion on the Gerdy’s tubercle

12. Scan proximally to see ITB’s (r) contact with lateral condyle (LC) for ITB friction syndrome
Two layers
Superficial: tendinous, inserts on Gerdy’s Tubercle
Deep: inserts on intermuscular septum
Tear may lead to avulsion at Gerdy’s Tubercle

13. LCL
LCL is in the same course as the popliteofibular ligament
Popliteofibular ligament (s) origins on the popliteal sulcus (PS) and attaches to posteromedial fibular styloid (Fib)
LCL (q) attaches to the fibular head, just superficial to the popliteofibular ligament

14. Biceps Femoris
Fix one end of probe on the fibular end, rotate proximal end until femur disappears from view
Biceps tendon inserts onto fibular head

15. Biceps femoris (BF)
Long head inserts on middle of posterolateral fibular head (Fib)
SH inserts medial to long head
Avulsion injury pattern common

16. ITB SYNDROME/PATHOLOGY
Korean J Pain. Oct 2013; 26(4): 387–391.
Published online Oct 2, doi: /kjp
PMCID: PMC
Diagnosis of Iliotibial Band Friction Syndrome and Ultrasound Guided Steroid Injection

20. Injection of ITB in a Runner
Fluid
Needle
Femur
Femur

21. Chronic ITB syndrome, refractory to conservative treatment
Needle
Local
25/27 G, 1-1/2”
Position
Lateral decubitus, injection side up
Medication
1% lidocaine
20mg triamcinolone

22. ITB PERITENDINOUS INJECTION
Skin Prep and anesthetic
LAX to transducer and ITB
Rotate transducer SAX to ITB
Needle is placed IN PLANE VIEW(Longitudinal to transducer)
Needle tip under ITB
Deliver medication
Pain control after the procedure

23. Scan Demonstration

24. Hands-on Scanning