Knee OA with persistent lateral pain and painful limitation of the flexion, Dynamic study probe is placed transverse over lateral femoral condyle at 90 degrees flexion the iliotibial band impinges between 2 osteophytes leading to severe pain and limitation of flexion,with extension the iliotibial band moves anterior and lateral away from the osteophytes with relief of pain.

3. *Female *53years * BMI: 35.53 kg/m2
* Chronic, Bilateral Asymmetric (LT>RT)
mechanical Knee Pain
*X-Ray: L-K G2
*Bilateral Knee OA
*α-D-glucosamine 500mg cap twice daily
+ NSAIDS

4. Lt knee Pain  8/10
more on lateral side  10/10
With painful limitation of flexion not > 90
degrees actively

5. MRI LEFT KNEE
-MILD Effusion and synovitis,
-Osteophytes,
-Cartilage defects at both femoral condyles
and post patellar surface,
-Intact menisci and cruciate ligaments .

6. Clinically
-Effusion (moderate)
-Tenderness along joint line more over
lateral femoral condyle
- Crepitus
- -ve Ant. & Post. drawer , McMurray and
Apley's Compression and Distraction Tests

7. Ultrasound study

8. Static scan

9. Main findings :
1- Suprapatellar pouch and 2 recesses :
Moderate effusion + Synovial thickening and
folding
2- Osteophytes
3- Meniscal subluxation (Med. meniscus)

10. TTT

11. 1-US guided Aspiration and IA steroids + HA
injection at the same session  1 week  2nd US
guided IA HA injection  1 week  3rd US guided
IA HA injection
Complete Relief of the diffuse knee pain, but
persistent lateral knee pain and Limitation of
flexion > 90 degrees

12. Ultrasound study

13. Static scan

16. Dynamic scan

17. Diagnosis

18. Iliotibial band impingement
(between 2 osteophytes at lateral
femoral condyle)

19. TTT

20. 1- Shock wave therapy
Or
2- Surgery

21. Discussion

22. Anatomy

25. Biomechanics