The Diagnostic Validity of Hip Provocation Maneuvers to Detect Intra-Articular Hip Pathology

Maslowski, Erin; Sullivan, William; Forster Harwood, Jeri; Gonzalez, Peter; Kaufman, Marla; Vidal, Armando; Akuthota, Venu

doi:10.1016/j.pmrj.2010.01.014

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Volume 2, Issue 3 , Pages 174-181, March 2010

The Diagnostic Validity of Hip Provocation Maneuvers to Detect Intra-Articular Hip Pathology

Erin Maslowski, MD
- 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^†
- Address correspondence to: E.M.
William Sullivan, MD
- Department of Physical Medicine and Rehabilitation, University of Colorado Denver, Denver, CO^‡
Jeri Forster Harwood, PhD
- Department of Pediatrics, University of Colorado Denver, Denver, CO^§
Peter Gonzalez, MD
- Department of Physical Medicine and Rehabilitation, University of Colorado Denver, Denver, CO^∥
Marla Kaufman, MD
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA^¶
Armando Vidal, MD
- Department of Orthopaedics, University of Colorado Denver, Denver, CO^⁎⁎
Venu Akuthota, MD
- Department of Physical Medicine and Rehabilitation, University of Colorado Denver, Denver, CO^††

Received 5 August 2009; accepted 22 January 2010.

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.

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⁎⁎ Disclosure: 5A
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See also Statistical Companion to this article,p. 182 in this issue.

PII: S1934-1482(10)00051-1

doi:10.1016/j.pmrj.2010.01.014

Refers to article:

Understanding and Critically Appraising Evidence About Diagnostic Tests
Cynthia Wilson Garvan
PM&R March 2010 (Vol. 2, Issue 3, Pages 182-186)
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