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The Diagnostic Validity of Hip Provocation Maneuvers to Detect Intra‐Articular Hip Pathology
Author(s) -
Maslowski Erin,
Sullivan William,
Forster Harwood Jeri,
Gonzalez Peter,
Kaufman Marla,
Vidal Armando,
Akuthota Venu
Publication year - 2010
Publication title -
pmandr
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.617
H-Index - 66
eISSN - 1934-1563
pISSN - 1934-1482
DOI - 10.1016/j.pmrj.2010.01.014
Subject(s) - provocation test , medicine , hip arthroscopy , straight leg raise , physical therapy , hip pain , internal rotation , prospective cohort study , visual analogue scale , surgery , range of motion , arthroscopy , pathology , mechanical engineering , alternative medicine , engineering
Objective To determine which hip provocation maneuvers best predict the presence of an intra‐articular hip pathology. Design Prospective diagnostic study. Setting Musculoskeletal clinic at a university‐based multispecialty group practice. Participants Fifty subjects referred for intra‐articular hip injection under fluoroscopic guidance. Interventions Subjects were examined with 4 pain provocation maneuvers before and after anesthetic intra‐articular hip injection administered under fluoroscopic guidance. Main Outcome Measurements Presence of intra‐articular hip pain generator was confirmed by ≥80% improvement on visual analog scale after intra‐articular hip injection. Results The most sensitive tests were flexion abduction external rotation (FABER) test and internal rotation over pressure (IROP) maneuver. For the FABER test, sensitivity was 0.82 (95% CI 0.57‐0.96); sensitivity for the IROP maneuver was 0.91 (95% CI 0.68‐0.99). The most specific test was the Stinchfield maneuver, with specificity at 0.32 (95% CI 0.14‐0.55). FABER and IROP had the highest positive predictive value, with 0.46 (95% CI 0.28‐0.65) and 0.47 (95% CI 0.29‐0.64), respectively. IROP had the highest negative predictive value at 0.71 (95% CI 0.25‐0.98). Conclusions IROP and FABER may be worthwhile components of the clinical evaluation of hip pain to determine intra‐articular hip pathology. These tests are nonspecific and therefore not necessarily negative in the absence of intra‐articular hip pathology. These hip provocation maneuvers are a useful part of an evaluation that includes history, further examination findings, and other diagnostic studies.