Abstract
PurposeClinical examination is an important part in the diagnosis of femoroacetabular impingement (FAI) syndrome. However, knowledge on reliability and validity of clinical diagnostic tests is scarce. The aims were to evaluate the inter-rater agreement and diagnostic accuracy of clinical tests to detect patients with FAI syndrome.MethodsEighty-one patients (49% women) were recruited. Two experienced raters performed impingement and range of motion (ROM) tests. Three criteria had to be fulfilled for the diagnosis of FAI syndrome: (1) symptoms; (2) CAM and/or Pincer morphology; and (3) being responder to intra-articular block injection. For inter-rater agreement, the Cohen’s kappa statistics were used (0.41–0.60 = moderate, 0.61–0.80 = substantial agreement). For diagnostic accuracy, sensitivity, specificity, positive and negative predictive values were calculated.ResultsAnterior impingement test (AIMT), FADIR test and FABER test showed kappa values above 0.6. All passive hip ROM, except extension, had kappa values above 0.4. AIMT and FADIR showed the highest sensitivity, i.e., 80%, with a specificity of 26% and 25%, respectively. Passive hip ROM in internal rotation with neutral hip position had a sensitivity of 29% and a specificity of 94%.ConclusionThe AIMT, FADIR and FABER tests were reliable between two experienced raters, while results from different raters for hip ROM should be interpreted with caution. The AIMT and FADIR test can only be used to rule out patients with FAI syndrome, while evaluation of ROM in internal rotation with neutral position may be more suitable to rule in patients with FAI syndrome.Level of evidenceII.
Highlights
Long-standing hip and groin pain is common among physically active people participating in high-impact sports [22, 47, 53] and among less physically active people [29, 41]
The Anterior impingement test (AIMT) and Flexion/ Adduction/Internal Rotation (FADIR) test can only be used to rule out patients with femoroacetabular impingement (FAI) syndrome, while evaluation of range of motion (ROM) in internal rotation with neutral position may be more suitable to rule in patients with FAI syndrome
We showed that only 50% of those who were referred to tertiary care were categorized as having hip-related groin pain [40]
Summary
Long-standing hip and groin pain is common among physically active people participating in high-impact sports [22, 47, 53] and among less physically active people [29, 41]. Long-standing hip and groin pain often limits a person’s ability to participate in physical as well as daily activities and reduces his or her quality of life [49, 54]. Diagnostics are challenging to perform in patients with long-standing hip and groin pain due to the likely. A triad of symptoms, clinical signs and radiological findings should be used to diagnose FAI syndrome [25]. The symptoms of FAI syndrome include motion-related or position-related pain in the hip or groin, with or without symptoms such as clicking, catching, locking and stiffness. To further confirm the diagnosis, image-guided intra-articular block injections can be used when all the other criteria have been met [11, 25]
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