Physical Examination of the Hip: Assessment of Femoroacetabular Impingement, Labral Pathology, and Microinstability

Abstract

Purpose of Review Determining the correct diagnosis can be challenging in patients presenting with hip pain. The physical examination is an essential tool that can aid in diagnosis of hip pathology. The purpose of this review is to provide an updated summary of recent literature on the physical exam of the hip, particularly as it relates to diagnosis of femoroacetabular impingement (FAI) syndrome, labral injury, and hip microinstability. Recent Findings Physical exam findings consistent with the diagnosis of FAI include reduced supine hip internal rotation and positive flexion-adduction-internal rotation maneuvers. Labral tears can be detected on exam with the Scour test. Studies demonstrate altered hip biomechanics in patients with FAI during activities such as walking and squatting. Those with FAI have slower squat velocities, slower sit-to-stand tests, and increased hip flexion moments during ambulation. Hip microinstability is a dynamic process, which can occur after prior hip arthroscopy. For hip microinstability, the combination of the three following positive tests (anterior apprehension, abduction-extension-external rotation, and prone external rotation) is associated with a 95% likelihood of microinstability as confirmed by examination under anesthesia at the time of surgery. Summary A comprehensive hip physical exam involves evaluation of the hip in multiple positions and assessing hip range of motion, strength, as well as performing provocative testing. A combination of physical exam maneuvers is necessary to accurately diagnose FAI syndrome and labral pathology as individual tests vary in their sensitivity and specificity. While an elevated level of suspicion is needed to diagnose hip microinstability, the provocative tests for microinstability are highly specific.

Physical Therapy Management of Hip Pain in Adults with Scoliosis: A Case Series

“…• Positive scour test, positive FABERE right hip, positive internal rotation over pressure (IROP) (Wong, Cogan and Zhang, 2022) for intraarticular hip pathology.…”

Hip Pain in Ballet Dancers: Evaluation and Management

“…Physical examination similarly provides a collection of datapoints, usually without definitive tests for specific pathology. 18 Tenderness to palpation may help isolate the location of pain, although it is often nonspecific. Passive ROM is assessed in all planes.…”

“…23,24 Conversely, a posterior apprehension test involves a posteriorly directed force on an adducted, flexed, and internally rotated hip. 18,24 An adjunct to physical examination, particularly in the setting of unclear clinical presentation, is the diagnostic injection of local anesthetic. An intra-articular hip injection can help localize the pathology, suggesting an intra-articular etiology associated with substantial resolution of pain.…”

“…23,24 Conversely, a posterior apprehension test involves a posteriorly directed force on an adducted, flexed, and internally rotated hip. 18,24…”

Two-Tiered Resection of Cam Lesions in Hip Femoroacetabular Impingement: Optimizing Femoral Head Sphericity

“…A positive test result is indicated by groin pain suggesting impingement of the femoral neck on the anterior rim of the acetabulum. 15,16 All patients are evaluated with plain radiographs including a weight-bearing anteroposterior radiograph of the pelvis, as well as a false-profile view and a 45 Dunn lateral view of the affected hip. From the Dunn lateral view, the alpha angle, as validated by Barton et al, 17 is calculated to determine whether a cam lesion is present.…”