Today is Day 2 of my 12 days of Hip Tips leading into Christmas. If you missed Day 1, you can read it here and collect your free resource. Yesterday we talked about the patient interview, the first important component of your diagnostic process. Today, we're moving on to the physical examination of your patient with hip pain. I've also got another free resource for you!
Tip #2 Use a test battery in the diagnosis of hip pain conditions
If there’s one thing we’ve learnt from the literature, it’s that when making a clinical diagnosis, there is very rarely a ‘sure thing.’ Study after study, particularly those of high quality with minimal bias, tell us that our diagnostic tests often have limited specificity and/or sensitivity, i.e. limited ability to rule in and/or out a particular diagnosis. So, do we abandon clinical testing and provide a generic intervention for ‘non-specific hip pain’? … I hope I just heard a resounding ‘NO’!
A thorough clinical reasoning approach allows us to bring together key pieces of information from the patient interview and physical assessment, to develop a plausible working diagnosis. The patient response to early intervention testing will further hone our diagnosis and treatment direction. But today, I wanted to make a particular point about the importance of using a test battery.
A test battery for Gluteal Tendinopathy/Greater Trochanteric Pain Syndrome
I have discussed this in more detail with regards to gluteal tendinopathy/Greater Trochanteric Pain Syndrome (GTPS) in my September blog. Our survey studies showed that despite high levels of clinician confidence in the diagnosis of GTPS, there appears to be overreliance on 2-3 physical tests and under-utilisation of a number of tests with good diagnostic utility1,2. In the blog, I demonstrated that in many cases, selecting only 2-3 tests for gluteal tendinopathy/greater trochanteric pain syndrome may not be adequate for achieving a correct diagnosis.
‘We don’t have time for more than 2-3 tests,’ you might say. But remember, getting the diagnosis right from the beginning, saves a lot of time and unnecessary patient (and clinician) distress in the longer term. If you are familiar with the tests, they are actually very quick to perform. All these tests are demonstrated in my video library.
A test battery for Femoroacetabular Impingement Syndrome (FAIS)
Also, remember that other physical examination findings may supplement information from pain provocation tests, forming part of your test battery. For example, relying on a FADIR/hip impingement test to diagnose femoroacetabular impingement syndrome (FAIS), will return fairly poor odds of achieving a correct diagnosis. Pain provocation tests for FAIS are best for ruling out FAIS when all tests are negative, while ROM testing has been shown to increase the likelihood of FAIS when range is restricted in patients with positive symptoms and imaging findings2.
Today, on Day 2 of our 12 Hip Tips for Christmas, I am sharing with you one of many clinical resources I have been busy developing for my exciting new initiative - Hip Academy - coming soon! This one is a 2- page pdf clinical resource outlining a test battery for FAIS, based on the current evidence. Photos, descriptions of these tests and their clinimetrics are included. The resource also covers patient interview and imaging features of FAIS. I hope you find it helpful. Merry Christmas!
Hope you enjoyed Day 2 of my 12 Hip Tips before Christmas. There are 10 more tips to come. Tomorrow there will be a special offer, so make sure you bookmark the blog page . See you tomorrow!
Click on the box above to read Day 1 miniblog
Click on the box above to read Day 3 miniblog
- French H, Grimaldi A, Woodley S, O'Connor L, Fearon A., 2019. An international survey of current physiotherapy practice in diagnosis and knowledge translation of greater trochanteric pain syndrome (GTPS). Musculoskeletal Science & Practice, 43, pp.122-126.
- Stephens G, O'Neill S, French HP, Fearon A, Grimaldi A, O'Connor L, Woodley S, Littlewood C., 2019. A survey of physiotherapy practice (2018) in the United Kingdom for patients with greater trochanteric pain syndrome. Musculoskeletal Science & Practice, 40, pp. 10-20.
- Pålsson, A., Kostogiannis, I. and Ageberg, E., 2020. Combining results from hip impingement and range of motion tests can increase diagnostic accuracy in patients with FAI syndrome. Knee Surgery, Sports Traumatology, Arthroscopy, 28(10), pp.3382-3392.