JOURNAL CLUB - HIP EXAMINATION
Presenter: Dr. Ryan Eardley
Date: September 13, 2016
Title: Diagnostic accuracy of clinical examination techniques for hip pain
Clinical 1 pager: Diagnostic accuracy of clinical tests of the hip
- Diagnostic accuracy of clinical tests of the hip: a systematic review with meta-analysis (Reiman et al, BJSM, 2013)
- Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: a systematic review with meta-analysis (Reiman et al, BJSM, 2015)
Hip OA
- All tests poor SN, unlikely alter post-test probability. Resisted adduction – more specific
Intraarticular/Labral tear
- 12 studies. Tests more SN then SP – variable pathologies discovered (chondral defects, arthritis, labral tear, FAI). Most studies low quality/high risk bias
- Flexion IR – highest SN (3 studies). Thomas test – SN and SP, highest +LR (1 study only)
- Conclusion: good screen for intra-articular pathology, poor at predicating nature of pathology
# hip/femur
- 5 studies. Patellar-pubic-percussion test (PPPT)– best SN/SP. Stethoscope placed lateral to pubic symphysis on suspected # side. Tap patella. Positive test – diminished sound
- Fulcrum test – 2 studies, both poor quality
AVN hip
- 1 high quality study – All HIV patients. Wide range SN/SP
Gluteal tendinopathy
- Tests more SP than SN. Best results – resisted external de-rotation test – SN+ SP, +LR 32 (but single study, n=17). Pathology – non specific [Symbol] tendinitis, partial tears, bursitis
Test (# of studies) | Sens | Sp | +LR/-LR | Reference standard | Test positive | |
Hip OA | Trandelenbergsign (2) | 50 | 70 | 1.83/0.82 | Xray | |
Resisted adduction(2) | 35 | 90 | 3.5/0.72 | Xray | ||
FABER(2) | 57 | 71 | 1.9/0.61 | Xray | ||
Impingement/labraltear | FADDIR (6) | 94-99 | 8 | 1/0.2 | MRA/arthroscopy | Pain/lock/click |
Flexion + IR (3) | 96 | 17 | 1.1/0.35 | MRA/arthroscopy | Pain/lock/click | |
Thomas Test (1) | 89 | 92 | 11.1/10.2 | Arthroscopy | Pain/click | |
FABER (3) | 42-81 | 18-75 | 1.1/0.72 | MRA/arthroscopy | Pain/lock/click | |
# hip/femur | PPPT (3) | 95 | 86 | 6.11/0.07 | Xray/CT/MRI | Less sound patella tap |
AVN hip | Restricted/painful movement (1) | 13-88 | 73-92 | 0.93/0.88 | MRI | |
Glut tendinopathy | Trandelenberg(3) | 61 | 92 | 6.83/0.25 | MRI | |
Resisted hip abduction (2) | 71 | 84 | 5.50/0.37 | MRI | ||
Resisted external de-rotation(1) | 88 | 97 | 36/0.2 | MRI |
References:
1. Reiman MP, Goode AP, Cook CE, Hölmich P, Thorborg K. Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: a systematic review with meta-analysis. Br J Sports Med. 2015 Jun;49(12):811. doi: 10.1136/bjsports-2014-094302. Epub 2014 Dec 16. Review.
2. Reiman MP, Goode AP, Cook CE, Hölmich P, Thorborg K
Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: a systematic review with meta-analysis. Br J Sports Med. 2015 Jun;49(12):811. doi: 10.1136/bjsports-2014-094302. Epub 2014 Dec 16.