What is Proximal ITB Syndrome?

Proximal ITB Syndrome (also called proximal iliotibial band enthesopathy) is an overuse injury at the upper (proximal) iliotibial band (ITB) insertion, located on the iliac tubercle or crest—not the more familiar lateral knee region. While ITB syndrome at the knee is common, this proximal variant is much less frequently recognized—only twelve cases were identified in one retrospective series.

Who Is Most Affected?

  • Commonly seen in female athletes, although it can also occur in older, overweight women.
  • Often misdiagnosed as greater trochanteric pain syndrome (GTPS) or other hip pathologies.

Key Symptoms & Presentation

  • Localized lateral hip pain over the iliac tubercle, often worsened with pressure, stretching, or hip adduction.
  • Pain may radiate down the lateral thigh and sometimes mimics snapping hip syndrome.
  • Named tests include palpation of the iliac crest region or stretching maneuvers (Ober’s test).

Imaging & Diagnosis

  • MRI is essential—must include coverage up to the iliac crest to capture findings like ITB thickening and peritubercular edema.
  • MRI often shows edema at the enthesis (attachment point) and thickening of ITB fibers.
  • Radiologists note proximal ITB changes are often missed if only typical hip slices are imaged.

Why It Matters

  • A unique and often overlooked cause of lateral hip pain, requiring different clinical management than knee ITB syndrome.
  • If misdiagnosed, patients may undergo incorrect treatments or unnecessary procedures.

Management Strategies

1. Conservative treatment (first-line)

  • Load management: reduce aggravating activities, like excessive running or hip adduction.
  • Physical therapy: target hip abductors and external rotators for strength, and gentle stretching of ITB and surrounding hip muscles.
  • NSAIDs and manual therapy: to reduce inflammation around the iliac crest/ITB.

2. Invasive options (if resistant)

  • Corticosteroid injection into the peritubercular region may offer relief.
  • Surgery is rarely required and usually reserved for refractory cases.

Takeaways

  • Proximal ITB syndrome is a distinct entity involving pain at the iliac tubercle due to ITB enthesopathy.
  • Suspect it in patients—especially women—with lateral hip pain not explained by typical GTPS or intra-articular hip disease.
  • Diagnosis hinges on targeted MRI and focused clinical exam.
  • Treatment emphasizes conservative management centered on load modification and muscle conditioning, with invasive interventions reserved for chronic cases.

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