Distal Iliotibial Band Injection

Other Names

Illustration of the iliotibial tract and associated structures

Illustration of the distal IT band

• Distal Iliotibial Band Injection
• Distal IT Band Injection
• Distal Iliotibial Band Peritendinous Injection
• Distal Iliotibial Band Percutaneous Tenotomy

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Background

Key Points

• Transducer: high frequency, linear
• Needle: 18 gauge for tenotomy, 22-25 gauge for injection, 1.5 to 2 inches
• Identify and avoid common peroneal nerve prior to beginning the procedure

Anatomy of the Iliotibial Band

• Composed of dense connective tissue approximately 2 mm thick
• Formed by the tensor fascia lata and gluteus maximus proximally at the greater trochanter
• Runs superficial to vastus lateralis over the lateral head of the femoral condyle
• Inserts into Gerdy's Tubercle of the tibia
• Distally, it merges with biceps femoris, vastus lateralis

Palpation Guidance vs Ultrasound Guidance

• There are no studies comparing palpation vs ultrasound guidance
• We strongly encourage the use of ultrasound to increase precision

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Indications

• Iliotibial Band Syndrome

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Contraindications

• Absolute
  • Anaphylaxis to injectates
  • Overlying cellulitis, skin lesion or systemic infection
• Relative
  • Can be treated with less invasive means
  • Hyperglycemia or poorly controlled diabetes
  • Lack of symptom improvement with previous injection

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Procedure

Long axis, out of plane view with needle and probe position

Long axis, out of plane approach ultrasound and needle vector marked (dots) and fluid under the IT band (asterisks)

Short axis in plane approach

Probe and needle position for IT band needle tenotomy

Needle victor on ultrasound for needle tenotomy

Equipment

• Sterile prep (i.e. chloraprep, chlorhexidine, iodine, etc)
• Gloves
• Needle: typically 21-25 gauge, 1.5 inch
• Syringe: 5-10 mL
• Gauze
• Ethyl Chloride
• Bandage
• Injectate
  • Local anesthetic
  • Corticosteroid
• Sterile probe cover

Ultrasound Findings

• Best visualized in long axis using high frequency linear probe
  • Depth is no more than 3 cm
• Common ultrasound findings include:
  • Thickening of the ITB
  • Hypoechoic changes around the ITB
  • Cortical irregularities at the lateral femoral condyle
  • Bursal distention
• Tenderness to sono-palpation may be illicited

Injection: Long Axis, Out of Plane

• Patient Position
  • Lateral decubitus
  • Knee flexed to 20-30 degrees, pillow between knees
• Transducer position
  • Long axis to the IT band, over the lateral femoral condyle
• Needle Approach/ Orientation
  • Out of plane
  • Posterior to anterior
• Target
  • Space between IT Band and lateral femoral condyle
• Pearls and Pitfalls
  • Identify and avoid the common peroneal nerve, lateral collateral ligament

Injection: Short Axis, In Plane

• Patient Position
  • Lateral decubitus
  • Knee flexed to 20-30 degrees, pillow between knees
• Transducer position
  • Short axis to the IT band, over the lateral femoral condyle
• Needle Approach/ Orientation
  • In plane
  • Posterior to anterior
• Target
  • Space between IT Band and lateral femoral condyle
• Pearls and Pitfalls
  • Identify and avoid the common peroneal nerve, lateral collateral ligament

Tenotomy: Long Axis, In Plane

• Patient Position
  • Lateral decubitus
  • Knee flexed to 20-30 degrees, pillow between knees
• Transducer position
  • Long axis to the IT band, over the lateral femoral condyle
• Needle Approach/ Orientation
  • In plane
  • Distal to proximal/ proximal to distal
• Target
  • Tendon portion or area of maximal pain
• Pearls and Pitfalls
  • Identify and avoid the common peroneal nerve, lateral collateral ligament
  • Fenestrate until he needle easily passes through the pathologic tissue

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Aftercare

• No major restrictions in most cases
• Can augment with ice, NSAIDS
• Consider Knee Compression Sleeve to reduce re-accumulation/ swelling

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Complications

• Infection
• Damage to surrounding tissue

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See Also

Internal

• Procedures Main
• Ultrasound Main
• Knee Pain Main

External

• https://www.sportsmedreview.com/blog/ultrasound-guided-it-band-injection/

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