The diagnostic validity of hip provocation maneuvers to detect intra-articular hip pathology.
OBJECTIVE
To determine which hip provocation maneuvers best predict the presence of an intra-articular hip pathology.


METHODS
Prospective diagnostic study.


METHODS
Musculoskeletal clinic at a university-based multispecialty group practice.


METHODS
Fifty subjects referred for intra-articular hip injection under fluoroscopic guidance.


METHODS
Subjects were examined with 4 pain provocation maneuvers before and after anesthetic intra-articular hip injection administered under fluoroscopic guidance.


METHODS
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.
Maslowski
Erin
E
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
Sullivan
William
W
Forster Harwood
Jeri
J
Gonzalez
Peter
P
Kaufman
Marla
M
Vidal
Armando
A
Akuthota
Venu
V
D000368:Aged; D005260:Female; D006621:Hip Joint / Q000473:pathology* / Q000502:physiology; D006801:Humans; D007592:Joint Diseases / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D056888:Patient Positioning / Q000379:methods*; D010808:Physical Examination / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016059:Range of Motion, Articular