What is the recommended procedure for an iliotibial (IT) band injection?

Recommended Procedure for Iliotibial (IT) Band Injection

The recommended procedure for an iliotibial band injection should follow aseptic technique with proper patient positioning, anatomical landmark identification, and use of appropriate equipment to ensure accurate medication delivery and patient safety. 1

Patient Preparation and Setting

• Obtain informed consent after explaining the procedure, injectable medication, potential benefits and risks 1
• Perform the procedure in a professional, clean, quiet, private, well-lit room 1
• Position the patient on an examination table that allows them to lie flat 1
• Ensure all equipment for aseptic procedures is available 1
• Have resuscitation equipment nearby 1

Equipment Required

• Sterile gloves
• Skin preparation supplies (alcohol, iodine disinfectant or chlorhexidine) 1
• Sterile drapes
• 25-27G needle for local anesthetic (if used)
• 22-25G needle for corticosteroid injection
• Syringes (5-10 mL)
• Corticosteroid preparation
• Local anesthetic (optional but recommended) 1
• Sterile gauze and bandage

Anatomical Considerations

The iliotibial band is a thick band of fascia that crosses the hip joint and extends distally to insert on the patella, tibia, and biceps femoris tendon. The most common site of inflammation is at the lateral femoral epicondyle where the IT band passes over this bony prominence 2.

Injection Procedure

1. Patient positioning: Place the patient in lateral decubitus position with the affected side up and the knee slightly flexed (20-30 degrees)

2. Identify injection site: Palpate the lateral femoral epicondyle and the area of maximal tenderness along the IT band, which is typically 2-3 cm proximal to the joint line

3. Prepare the skin: Clean the area with antiseptic solution using aseptic technique 1

4. Prepare medication:

   • Draw up corticosteroid (typically 40mg methylprednisolone or equivalent)
   • Consider adding local anesthetic (e.g., 2-3 mL of 1% lidocaine) 1
   • Change needle before injection to avoid tracking skin contaminants 1

5. Administer local anesthetic (if using separately):

   • Consider offering local anesthetic to reduce procedural pain 1
   • Infiltrate 1-2 mL of 1% lidocaine into the subcutaneous tissue

6. Perform injection:

   • Insert the needle perpendicular to the skin at the point of maximum tenderness
   • Advance until reaching the area between the IT band and the lateral femoral epicondyle
   • Aspirate to ensure the needle is not in a blood vessel
   • Inject the medication slowly
   • Consider a fan-like distribution of small amounts of the solution

7. Post-injection care:

   • Apply pressure with sterile gauze if needed
   • Apply a small adhesive bandage
   • Advise the patient to avoid overuse of the injected area for 24 hours, though complete immobilization is discouraged 1

Follow-up and Monitoring

• Monitor the patient for 15-30 minutes after the procedure for any immediate adverse reactions
• Inform diabetic patients about the risk of transient increased glycemia following corticosteroid injection, particularly from the first to third day 1
• Advise patients to monitor glucose levels if they have diabetes 1

Potential Complications and Precautions

• Infection (rare with proper aseptic technique)
• Post-injection flare (temporary increase in pain)
• Skin depigmentation or atrophy with superficial injection
• Bleeding or bruising at the injection site
• Patients on anticoagulants can still receive the injection, but may have increased risk of bruising 1

Treatment Considerations

• IT band syndrome often responds to conservative treatment involving stretching of the iliotibial band and strengthening of the gluteus medius 2
• Corticosteroid injections should be considered if visible swelling or pain with ambulation persists for more than three days after initiating conservative treatment 2
• A small percentage of patients may be refractory to conservative treatment and injections, potentially requiring surgical release of the iliotibial band 2

Remember that accuracy of injection is crucial for therapeutic success. If available, ultrasound guidance may be used to improve accuracy, though landmark-guided injection is commonly performed for this superficial structure 1.