The broken wing sign: a new clinical test to detect gluteus medius pathology with and without fatty infiltration

Review written by Dr Sandy Hilton info

Key Points

  1. The broken wing sign demonstrated high diagnostic accuracy.
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BACKGROUND AND OBJECTIVE

Lateral hip pain following total hip arthroplasty and hip fractures is commonly due to gluteus medius tendon dysfunction including tears and muscle atrophy (1). Currently magnetic resonance imaging (MRI) is the gold standard for assessing tears and fatty infiltration but access and cost limit use (2).

The authors of this paper proposed a new musculoskeletal clinical test for early detection of abductor insufficiency. They particularly were interested in a test that would correlate with MRI findings in a non-weightbearing position. They report the limitations of the Trendelenburg sign and resisted hip abduction and propose “The Broken Wing Sign” as a novel examination to detect gluteus medius tears and assess for muscle atrophy.

Therefore, this study aimed to establish the diagnostic accuracy and clinical utility of the Broken Wing Sign.

Currently magnetic resonance imaging is the gold standard for assessing gluteus medius tendon tears and fatty infiltration but access and cost limit use.
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This is a good test to use in the clinic for those who have poor balance, use assistive devices, or have pain in standing which make the use of the Trendelenburg test unavailable.

METHODS

  • This was a prospective study of 59 patients that were referred to a specialty clinic for suspected hip abductor insufficiency (75 hips). Clinical MRI examinations were performed on each hip in the study.
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