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PM R. 2010 Mar;2(3):174-81. doi: 10.1016/j.pmrj.2010.01.014.

The diagnostic validity of hip provocation maneuvers to detect intra-articular hip pathology.

Author information

1
Department of Physical Medicine and Rehabilitation, University of Colorado Denver, Mail Stop F-493, 12631 East 17th Avenue, Academic Office 1, Room 2513, Aurora, CO 80045, USA. elmaslow@hotmail.com

Abstract

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 > or =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.

PMID:
20359681
DOI:
10.1016/j.pmrj.2010.01.014
[Indexed for MEDLINE]

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