Abstract
Purpose of ReviewDetermining 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 FindingsPhysical 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.SummaryA 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.
Highlights
While a multitude of pathologies can affect the hip and surrounding structures, physical examination remainsThis article is part of the Topical Collection on HIP/femoroacetabular impingement (FAI) Upright ExamUpright examination of the patient can provide crucial information for detection of hip pathology and includes evaluation of both stance and gait
The position of hip flexion maximizes the intracapsular volume of the hip joint, which can be seen in pathologies such as septic hip
The authors prefer to begin the supine exam with a log roll test, which has been described as one of the most specific tests for hip pathology [1]
Summary
Upright examination of the patient can provide crucial information for detection of hip pathology and includes evaluation of both stance and gait. A positive Trendelenburg sign occurs when a patient performs a single-leg stance and the contralateral pelvis drops due to abductor weakness [2]. A Trendelenburg gait can often be correlated with the Trendelenburg sign and occurs with the pelvis dropping on the opposite side of the stance leg. An antalgic gait occurs with shortening of the stance phase, increased hip flexion, and avoidance of hip extension on the affected side [1]. Studies by Samaan et al showed that patients with FAI had increased hip flexion loading moments compared to controls and shortened hip extension phase with walking [6, 11]. A study comparing hip biomechanics during double and single-leg squats showed exaggerated biomechanical differences during the single-leg squat task in patients with FAI, with slower squat velocities, less peak hip adduction, and lower hip abduction and extension moments [5]. Similar to the double-leg squat, one should assess the squat in both the coronal and sagittal plane, paying attention to form, stability, and depth
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