Is the internal rotation lag sign a sensitive test for detecting hip abductor tendon ruptures after total hip arthroplasty?

Abstract

IntroductionTotal hip arthroplasty (THA) is one of the most frequently performed procedures in orthopaedics and weakness of external rotators is often recognized thereafter. However, the etiology of lateral hip pain is multifaceted. For the diagnosis of abductor tendon rupture, magnetic resonance imaging (MRI) is the gold standard. As not every patient can be subjected to MRI, a clinical diagnostic test for easy detection of lesions of the abductor tendon is missing. Here, we present the internal rotation lack sign indicating abductor tendon pathology.MethodsThe patient is placed in lateral position on a stretcher with hips and knees in neutral position. The knee is flexed to 45° and the hip passively abducted and elevated by the investigator. With the foot passively abducted, the patient is then asked to bring his knee in direction to the examination table. This motion is also tested passively. The test is regarded positive, if no internal rotation is possible and/or if this is painful. If groin pain is elicited during either of the exercises, the test is also rated positive.ResultsWe evaluated this test in 20 patients clinically and by magnetic resonance imaging (MRI). All patients demonstrated a positive internal rotation lag sign. Twelve of them lag of internal rotation and evidence of anterior abductor tendon rupture on MRI, 8 with lag of internal rotation and no evidence of abductor tendon rupture.ConclusionThe new clinical diagnostic sign presented here may improve the diagnosis of abductor tendon rupture in the future.Level of Evidence: Diagnostic study, level I.

Hip Abductor Deficiency after Total Hip Arthroplasty: Diagnostic and Therapeutic Methods

“…Ein spezifischer Test der Mm. gluteus medius und minimus ist das Internal Rotation Lag Sign 22 . Dabei liegt der Patient in Seitenlage auf der Untersuchungsliege mit Hüfte und Knie in Neutralposition.…”

“…Patients with gluteal deficiency exhibit a marked reduction in strength or complete loss of abduction ability in such instances. Internal rotation lag sign is a clinical test for the gluteus medius and minimus muscles [22]. The patient is placed in the lateral position on the examination table, with the hip and knee in a neutral position.…”

“…Ein spezifischer Test der Mm. gluteus medius und minimus ist das Internal Rotation Lag Sign [22]. Dabei Auch das Testen der aktiven Innenrotation gegen Widerstand bei 90°gebeugter und 10°außenrotierter Hüfte sowie 90°gebeugtem Knie in Rückenlage ist möglich [23,24].…”

Labral reconstruction with tendon allograft: histological findings show revascularization at 8 weeks from implantation

“…On physical examination the patient presented with limited external rotation of the hip, positive Faber test, positive impingement test and positive Ribas decompression test in both hips [ 16 ]. In addition, the patient referred bilateral trochanteric pain with negative Ossendorf test [ 17 ].…”