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Injection-induced gluteus muscle contractures: diagnosis with the "reverse Ober test" and surgical management
William F Scully1, Klane K White, Kit M Song
1*Orthopaedics Service, Martin Army Community Hospital, Fort Benning, GA †Seattle Children's Hospital, Seattle, WA ‡Shriners Hospitals for Children, Los Angeles, CA.
Insights
Injection-induced gluteus maximus contracture is a difficult orthopedic condition to diagnose in adopted children. Early recognition of the "reverse Ober test" can lead to effective surgical correction of this hip abduction contracture.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Adoption medicine
Background:
- Increasing adoption rates highlight the need to recognize medical conditions in adopted children.
- Injection-induced gluteus maximus contracture is an underdiagnosed orthopedic issue.
- Familiarity with its etiology, pathoanatomy, and examination findings is crucial for diagnosis.
Purpose of the Study:
- To review the diagnosis and treatment of injection-induced gluteus maximus contracture.
- To highlight the importance of the "reverse Ober test" in diagnosis.
- To improve recognition and treatment of this condition in adopted children.
Main Methods:
- Retrospective case series of 4 patients.
- Review of patient history, physical examination, and treatment outcomes.
- Surgical treatment involved division of contracted gluteus tissue.
Main Results:
- All patients were adopted from developing countries and presented with similar physical findings.
- Patients exhibited buttock contractures, scars, and an out-toed gait.
- A positive "reverse Ober test" indicated hip abduction contracture, which resolved after surgery.
Conclusions:
- Injection-induced gluteus maximus contracture is rare in developed countries but requires recognition.
- The "reverse Ober test" is a key diagnostic indicator.
- Surgical intervention can effectively correct functional impairments associated with gluteus contracture.
Background:
Adoption rates are increasing in the United States and other developed countries. A large proportion of adopted children have been found to have unsuspected medical diagnoses, including orthopedic problems. One condition, termed injection-induced gluteus maximus contracture, has been previously described in several case series and can be difficult to diagnose if unfamiliar with this condition. By reviewing the etiology and pathoanatomy of this problem, as well as the typical examination findings, including the near-pathognomonic-positive "reverse Ober test," treating providers will be better prepared to recognize and properly treat this condition.
Methods:
This is a retrospective review of 4 patients treated at our institution for injection-induced gluteus maximus contracture. Patient history, physical examination findings, and treatment outcomes were recorded. All had undergone surgical treatment through a longitudinal incision along the posterior margin of the iliotibial band, with division of thickened, contracted gluteus tissue down to the ischial tuberosity.
Results:
All 4 of the patients were adopted from orphanages in developing countries. Chief complaints of the patients varied, but physical examination findings were very consistent. Three of the 4 patients had undergone rotational osteotomies for presumed femoral retroversion before their diagnosis and treatment for injection-induced gluteus maximus contracture. All patients had concave, atrophic buttock contours and numerous punctate buttock scars. All walked with an out-toed gait and had marked apparent femoral retroversion. Each patient was found to have full hip adduction when the hip was extended but a hip abduction contracture when the hip was flexed. This finding of increasing abduction as an extended/adducted hip is flexed to 90 degrees is described as a positive "reverse Ober test." After surgical treatment, all hips could adduct to neutral from full extension to full flexion.
Conclusions:
Although common in some countries, such as Russia and China, injection-induced gluteus muscle contractures are seldom seen in the United States and other developed countries. Diagnosis of this condition can be difficult leading to inappropriate treatment. Knowledge of the clinical presentation typical of a gluteus contracture and of the pathognomonic finding of a "reverse Ober test" can facilitate an effective surgical procedure to correct the associated functional impairment.
Level Of Evidence:
Level IV: retrospective case series.
