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

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• 作者：Erin Maslowski ; MD^a ; ^{elmaslow@hotmail.com} ; William Sullivan ; MD^b ; Jeri Forster Harwood ; PhD^c ; Peter Gonzalez ; MD^d ; Marla Kaufman ; MD^e ; Armando Vidal ; MD^f ; Venu Akuthota ; MD^g
• 刊名：PM&R
• 出版年：2010
• 出版时间：March 2010
• 年：2010
• 卷：2
• 期：3
• 页码：174-181
• 全文大小：719 K

文摘

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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 ?0 % 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.