American Board of Internal Medicine (ABIM) Certification Practice Exam

In testing for iliotibial band syndrome, what does a positive Noble test indicate?

1. Complete recovery of the joint

2. Patellar instability

3. Reproduced patient pain

4. Joint effusion

The correct answer is: Reproduced patient pain

A positive Noble test is specifically utilized to assess for iliotibial band syndrome, which is characterized by pain along the lateral aspect of the knee due to friction of the iliotibial band over the femoral epicondyle. During the Noble test, the examiner typically applies pressure to the lateral femoral condyle while the knee is flexed and extended. If this maneuver reproduces the patient's pain, it confirms irritation of the iliotibial band, indicating the presence of iliotibial band syndrome. This positive response is crucial in establishing a diagnosis for this condition, as the pain experienced by the patient directly correlates with the mechanics of the iliotibial band. Understanding that the Noble test aims at eliciting pain helps distinguish it from other conditions which may have similar presentations but would not produce the same specific pain response.