Learn all about gerdy’s tubercle swelling, palpation, pain and ultrasound.
It is a ‘small rounded protuberance’ on the anterolateral (front, outer) aspect of the upper tibia (shin bone) where the ITB inserts. Its name is credited to French surgeon Pierre Nicolas Gerdy.
On palpation, the ITB feels tight and rigid with tenderness along its distal end (over lateral femoral condyle), and perhaps also the hip. Ligamentous and meniscal tests will be negative, however single or multiple trigger points will be elicited in the lateral distal thigh (across ITB above the joint line). Gerdy’s tubercle will be surprisingly painful. Palpation of the lateral femoral epicondyle during flexion/extension may result in a “creak sign” as the ITB rubs over the femoral prominence.
Commonly affect young patients who are physically active, most often long distance runners or cyclists. The exact prevalence is unknown, but one study has found the prevalence among actively training marines to be higher than 20% 5. Iliotibial band syndrome accounts for 12% of running-related overuse injuries.
Pain at the lateral knee joint is the presenting symptom with point tenderness 1-2 cm above the lateral joint line. Pain is usually worse with downhill running and increases throughout an episode of activity.
What is Gerdy’s Tubercle?
Gerdy’s tubercle is the area where the iliotibial band and the fascia lata go into the tibia. The feature is named after Pierre Nicolas Gerdy, the 19th-century French surgeon who first described it. The tibia, also known as the shankbone or the shinbone, is one of the two bones of the lower leg, which is the part below the knee; the other lower leg bone is the fibula. The tibia is the bigger and stronger of the two and is known as the body’s sturdiest weight-bearing bone. Gerdy’s tubercle is located at the tibia right below the knee joint.
Gerdy’s Tubercle Swelling
Swelling at the Gerdy’s tubercle may occur due to the iliotibial band friction syndrome. In this syndrome, due to over usage of connective tissue (which forms iliotibial band) may cause severe pain to the gerdy’s tubercle and may result in swelling of the outer part of knee. Swelling in the gerdy’s tubercle may also occur due to excessive accumulation of fluid in the space of knee around gerdy’s tubercle. This accumulated fluid in the knee, may cause friction while working with knee and as a result swelling occurs.
Gerdy’s Tubercle Palpation
Patients with iliotibial band syndrome often demonstrate tenderness on palpation of the lateral knee approximately 2 cm above the joint line. Tenderness frequently is worse when the patient is in a standing position and the knee is flexed to 30 degrees. At this angle, the iliotibial band slides over the femoral condyle and is at maximal stress, thus reproducing the patient’s symptoms. Swelling may be noted at the distal iliotibial band and thorough palpation of the affected limb may reveal multiple trigger points in the vastus lateralis, gluteus medius, and biceps femoris. Palpation of these trigger points may cause referred pain to the lateral aspect of the affected knee. Strength of the lower extremity should be assessed with particular emphasis on examining the knee extensors, knee flexors, and hip abductors. Weakness in these muscle groups has been associated with the development of iliotibial band syndrome.
Gerdy’s Tubercle Pain
The gerdy’s tubercle pain may be caused by the tightness of the band in relation to the repetitive lateral friction of the iliotibial band rolling over a small, fluid-filled sac at the lateral femoral epicondyle. During such physical activity, the pain may be described as sharp, burning pain when the knee is flexed and extended. Walking may relieve symptoms and the individual may walk with a stiff gait to avoid the IT Band rubbing over the condyle.
Gerdy’s Tubercle Ultrasound
Gerdy’s tubercle ultrasound is used for assessment and evaluation. The use of ultrasound for evaluation of the knee is increasing. It is where the iliotibial band and anterior tibialis muscle inserts. Ultrasound allows visualization of the impingement by assessing dynamic motion of the ITB through knee flexion and extension. Imaging evaluation of an acutely injured knee might only demonstrate subtle abnormalities, such as avulsion fractures or effusion that are generally easily detected on conventional radiographs. Nevertheless, their recognition by the physician, coupled with an awareness of their origin and of the related underlying injury mechanism, might lead to further imaging investigation for the detection of co-existent but less evident fractures and for the evaluation of associated ligamentous, tendinous or meniscal injuries.