Physical examination tests for hip dysfunction and injury

Physical examination tests for hip dysfunction and injury
Introduction Diagnosis of non-arthritic hip pathology is challenging. In the last 10 years the understanding of hip pathology and femoroacetabular impingement (FAI) has exploded,1 although in the spectrum of medicine knowledge this area is relatively new.2 As such, expertise is often located in irregular pockets of providers, resulting in variable understanding and recognition in the larger medical community. Patients with intra-articular hip pathology have been reported to see 3.3 providers on average before being correctly diagnosed.3 ,4 Thus, it is not uncommon for a patient to undergo inappropriate imaging and, unfortunately, inappropriate treatments including epidural steroid injections, hernia repairs and even lumbar spine fusion. Furthermore, long-standing hip pain results in surrounding dysfunction of the low back, pelvis and even knee, with poorer outcomes in patients with concomitant conditions.5 These factors converge to make diagnosis of hip pathology one of the greatest challenges currently facing the orthopaedic and sports medicine field. Disorders of the hip can largely be categorised as intra-articular or extra-articular. Intra-articular disorders are driven by pathology at opposite ends of the morphological spectrum; acetabular dysplasia or FAI.3 ,6 Labral tears are recognised to be the pain generator in these disease states. Extra-articular disorders include psoas tendon disorders such as internal snapping hip and tendinitis, peritrochanteric space disorders such as external snapping hip and abductor tendon tears, and deep gluteal space syndrome, previously known as piriformis syndrome.7 Whereas imaging is clearly important for correct diagnosis, false positives with MRI and MRI with arthrogram (MRA) are common, requiring providers to determine whether a distinct pathology is actually symptomatic, further relying on accurate and efficient physical examination. Solving this problem requires two primary approaches: (1) identify the most accurate-specific hip physical examination (HPE) tests and (2) provide detailed descriptions and instructions to providers to allow reproduction and application of these tests. The first was recently addressed by Reiman et al8 in a systematic review and meta-analysis. This article encompassed a detailed execution of the HPE tests with the greatest clinical utility as outlined by that group. In addition, the publication discussed the discrepancy in test description and reason for caution in test interpretation when appropriate. Original article and pictures take http://bjsm.bmj.com/content/49/6/357 site