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

Wiley - Tập 2 Số 3 - Trang 174-181 - 2010
Erin Erin, William William, Jeri Jeri, Peter Peter, Marla Marla, Armando Armando, Venu Venu

Tóm tắt

ObjectiveTo determine which hip provocation maneuvers best predict the presence of an intra‐articular hip pathology.DesignProspective diagnostic study.SettingMusculoskeletal clinic at a university‐based multispecialty group practice.ParticipantsFifty subjects referred for intra‐articular hip injection under fluoroscopic guidance.InterventionsSubjects were examined with 4 pain provocation maneuvers before and after anesthetic intra‐articular hip injection administered under fluoroscopic guidance.Main Outcome MeasurementsPresence of intra‐articular hip pain generator was confirmed by ≥80% improvement on visual analog scale after intra‐articular hip injection.ResultsThe 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).ConclusionsIROP 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.

Tài liệu tham khảo

10.1093/oxfordjournals.epirev.a036019 10.1016/j.joca.2007.02.002 10.1002/art.23310 Illgen R.L., 2006, The diagnostic and predictive value of hip anesthetic arthrograms in selected patients before total hip arthroplasty, J Arthroplasty, 21, 724, 10.1016/j.arth.2005.08.017 Magee D., 2002, Orthopaedic physical assessment Bogduk N., 2004, Spinal diagnostic treatment procedures Pepe M., 2003, The statistical evaluation of medical tests for classification and prediction 10.1111/j.1526-4637.2006.00153.x 10.1177/0363546504266480 Pateder D.B., 2007, Use of fluoroscopically guided intra‐articular hip injection in differentiating the pain source in concomitant hip and lumbar spine arthritis, Am J Orthop, 36, 591 Porterfield J.A., 1991, Mechanical low back pain: perspectives in functional anatomy 10.1097/00042752-200305000-00005 10.1016/j.arthro.2008.04.075 10.1097/BPO.0b013e31818e194f 10.1053/j.otsm.2004.09.007 10.1007/s00167-003-0390-7 10.1097/00003086-200402000-00044 10.1093/rheumatology/40.5.506 10.1002/art.1780340502 10.2519/jospt.2008.2753 10.1093/rheumatology/kel217 10.1302/0301-620X.80B2.8299
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Wiley

Tập 2 Số 3

174-181

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