logo-121x133

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)SensSp+LR/-LRReference standardTest positive
Hip OATrandelenbergsign (2)50701.83/0.82Xray 
 Resisted adduction(2)35903.5/0.72Xray 
 FABER(2)57711.9/0.61Xray 
Impingement/labraltearFADDIR (6)94-9981/0.2MRA/arthroscopyPain/lock/click
 Flexion + IR (3)96171.1/0.35MRA/arthroscopyPain/lock/click
 Thomas Test (1) 899211.1/10.2ArthroscopyPain/click
 FABER (3)42-8118-751.1/0.72MRA/arthroscopyPain/lock/click
# hip/femur PPPT (3)95866.11/0.07Xray/CT/MRILess sound patella tap
AVN hip Restricted/painful movement (1)13-8873-920.93/0.88MRI 
Glut tendinopathyTrandelenberg(3)61926.83/0.25MRI 
 Resisted hip abduction (2)71845.50/0.37MRI 
 Resisted external de-rotation(1)889736/0.2MRI 

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.