A 26-year-old woman comes to the office for evaluation of right knee pain. She is training for an upcoming marathon but is unable to run more than a mile without pain. The pain is sharp and most prominent at the lateral aspect of the knee; it is worse when descending stairs and better with ice and rest. There has been no recent trauma to the knee. Vital signs are within normal limits. On examination, the leg is soft with no effusion or redness around the knee. Knee ligament testing shows no instability and range of motion is full. There is no clicking or popping; however, there is an area of tenderness 2 cm proximal to the right lateral joint line. Which of the following is the most likely diagnosis in this patient?

Question

A 26-year-old woman comes to the office for evaluation of right knee pain.  She is training for an upcoming marathon but is unable to run more than a mile without pain.  The pain is sharp and most prominent at the lateral aspect of the knee; it is worse when descending stairs and better with ice and rest.  There has been no recent trauma to the knee.  Vital signs are within normal limits.  On examination, the leg is soft with no effusion or redness around the knee.  Knee ligament testing shows no instability and range of motion is full.  There is no clicking or popping; however, there is an area of tenderness 2 cm proximal to the right lateral joint line.  Which of the following is the most likely diagnosis in this patient?

Quizplus · Accepted Answer

11ec25c8_d2b9_c69c_bc81_c1fa5d89e575_MD0003_00 The iliotibial band (tract) is a thickened fibrous structure in the deep fascia of the lateral thigh. It contributes to the insertion of a number of hip and thigh muscles (eg, gluteus maximus) and stabilizes the lateral thigh during flexion and extension of the knee. Iliotibial (IT) band syndrome is a common overuse injury characterized by poorly localized lateral knee pain originating in the region where the distal IT band passes over the lateral femoral epicondyle (LFE). It is often seen in inexperienced runners starting a new or more strenuous training regimen. distal IT band The diagnosis of IT band syndrome is based primarily on clinical findings. Examination may show tenderness proximal to the lateral joint line near the LFE; the pain can often be reproduced with pressure over the IT band just proximal to the LFE during flexion of the knee (eg, Noble test). Initial management includes activity modification and lower extremity stretching and strengthening exercises. (Choice B) Lateral collateral ligament sprains are uncommon and typically caused by a blow to the medial aspect of the knee. Examination shows joint line tenderness and varus laxity. (Choice C) In young patients, lateral meniscus injuries are typically caused by acute trauma rather than overuse. Associated symptoms include catching, popping, or locking during movement and sometimes a give-way sensation. Small effusions are common, and tenderness, if present, is at the joint line. (Choice D) Patellofemoral pain syndrome is a common cause of knee pain in young, physically active women, but it typically presents with anterior pain that is reproduced by squatting. anterior pain (Choice E) Pes anserinus pain syndrome, often termed pes anserine bursitis, causes medial (not lateral) knee pain. Tenderness in this disorder is distal to the joint line in the region where the conjoined tendon of the semitendinosus, gracilis, and sartorius inserts on the tibia. conjoined tendon Educational objective: Iliotibial (IT) band syndrome is characterized by poorly localized lateral knee pain. It is common in inexperienced runners starting a new or more strenuous training regimen. Examination shows tenderness proximal to the joint line; pressure over the IT band just proximal to the lateral femoral epicondyle during flexion of the knee reproduces the pain. References: The iliotibial tract: imaging, anatomy, injuries, and other pathology. (http://www.ncbi.nlm.nih.gov/pubmed/28238018) Iliotibial band syndrome: evaluation and management. (http://www.ncbi.nlm.nih.gov/pubmed/22134205)

A 26-Year-Old Woman Comes to the Office for Evaluation of Right