Concurrent Validation and Reference Values of Gluteus Medius Clinical Test

Vastus Lateralis Transfer for Reconstruction of Hip Abduction following Superior Gluteal Nerve Injury

A 71-year-old man who had hip abductor insufficiency due to a chronic injury to the right superior gluteal nerve injury after lipoma resection presented to our outpatient clinic 1.5 years postoperatively with persistent pain, atrophy of the gluteus medius muscle, and Trendelenburg sign with a corresponding limp. A magnetic resonance imaging scan and neurophysiological diagnostics confirmed a chronic lesion of the superior gluteal nerve with completed reinnervation and absent pathological spontaneous activity, excluding neurosurgical options to restore hip abduction. Following interdisciplinary evaluation of the patient's case, we performed a vastus lateralis transfer in May 2023 to stabilize the right hip joint. The entire vastus lateralis muscle was carefully freed from the surrounding tissue, and its attachment to the quadriceps tendon was separated. The proximal section of the lateral vastus was then fixed to the ilium and greater trochanter, while the muscle's distal portion was sutured to a more proximal part of the quadriceps muscle. The postoperative course was without any complications, and the patient left the hospital with an abduction splint 10 days after surgery. When he presented to our outpatient clinic 10 weeks after surgery, he reported a significantly improved gait and reduction of pain. Trendelenburg sign was now absent, but right knee function was not impaired and the patient was able to ambulate without the regular need for an orthosis. A transfer of the vastus lateralis muscle is therefore a valuable option to restore hip abductor function in cases of chronic nerve lesions which exclude neurosurgical options.

Intra- and Inter-Rater Reliability of Strength Measurements Using a Pull Hand-Held Dynamometer Fixed to the Examiner's Body and Comparison with Push Dynamometry

Hand held dynamometers (HHDs) are the most used method to measure strength in clinical sitting. There are two methods to realize the assessment: pull and push. The purpose of the present study was to evaluate the intra- and inter-rater reliability of a new measurement modality for pull HHD and to compare the inter-rater reliability and agreement of the measurements. Forty healthy subjects were evaluated by two assessors with different body composition and manual strength. Fifteen isometric tests were performed in two sessions with a one-week interval between them. Reliability was examined using the intra-class correlation (ICC) and the standard error of measurement (SEM). Agreement between raters was examined using paired t-tests. Intra- and inter-rater reliability for the tests performed with the pull HHD showed excellent values, with ICCs ranging from 0.991 to 0.998. For tests with values higher than 200 N, push HHD showed greater differences between raters than pull HHD. Pull HHD attached to the examiner’s body is a method with excellent reliability to measure isometric strength and showed better agreement between examiners, especially for those tests that showed high levels of strength. Pull HHD is a new alternative to perform isometric tests with less rater dependence.