Martin (2010) — The pattern and technique in the clinical evaluation of the adult hip: the common physical examination tests of hip specialists.

The Pattern and Technique in the Clinical Evaluation of the Adult Hip: the Common Physical Examination Tests of Hip Specialists.

·Arthroscopy·2010·192 citations·Hip & Knee

This study asked six hip specialists to independently examine 11 patients with hip pain, recording every test performed on video. The goal was to identify which examination maneuvers are used consistently enough to form a standardized hip exam protocol.

Key Findings

Flexion ROM and internal rotation ROM were the two most universally used tests, each performed in 98% of examinations — nearly every hip specialist starts here.
The 10 core tests performed >50% of the time by hip specialists are:
–Supine. Flexion ROM (98%), IR ROM (98%), ER ROM (86%), passive supine rotation (76%), FADDIR (70%), straight leg raise against resistance (61%), FABER (52%)
–Standing. Gait (86%), single-leg stance phase (77%)
–Prone. Femoral anteversion test (58%)
Performing more tests does not improve diagnostic yield rate. Examiner 4 ran 34 tests with only 20% positive, while examiner 2 ran 13 tests with 36% positive. A focused exam outperforms a shotgun approach.
Interrater reliability for the most common provocative tests is only fair:
–FABER. κ = 0.63
–FADDIR. κ = 0.58
–Passive supine rotation. κ = 0.61
–This means technique standardization matters as much as test selection.
All six specialists followed the same positional sequence. standing, seated, supine, lateral, prone. Even though the specific tests within each position varied.

Board PearlThe 10 core hip exam tests used by specialists include FADDIR, FABER, Stinchfield, passive rotation, gait, single-leg stance, ROM, and femoral anteversion.

Clinical Relevance

In 2010, there was no consensus hip examination protocol — unlike the shoulder or knee, no standardized battery existed, making multicenter research and trainee education inconsistent.

This paper is the practical reason we teach FADDIR and FABER as the core provocative tests for hip impingement and labral pathology. When a patient presents with groin or anterior hip pain, start supine: flexion ROM, internal and external rotation ROM, FADDIR, and Stinchfield. These are the tests every specialist agrees on.

Know the positive test definitions cold: FADDIR is positive with pain at 90° flexion/adduction/IR; Stinchfield is positive with groin pain resisting a straight leg raise to 45° (the psoas loads the anterior labrum under resistance). The fair kappa values for these tests (0.58-0.63) are a reminder that a poorly performed FADDIR is a meaningless FADDIR. Technique is the variable.

Supplemental

The Pattern and Technique in the Clinical Evaluation of the Adult Hip: the Common Physical Examination Tests of Hip Specialists.

Martin, Safran, et al.·Arthroscopy·2010·192 citations·Hip & Knee

The Pattern and Technique in the Clinical Evaluation of the Adult Hip: the Common Physical Examination Tests of Hip Specialists.

Key Findings

Clinical Relevance

Related Articles

The Pattern and Technique in the Clinical Evaluation of the Adult Hip: the Common Physical Examination Tests of Hip Specialists.

Key Findings

Clinical Relevance

Related Articles

The Pattern and Technique in the Clinical Evaluation of the Adult Hip: the Common Physical Examination Tests of Hip Specialists.

Key Findings

Clinical Relevance

Related Articles

The Pattern and Technique in the Clinical Evaluation of the Adult Hip: the Common Physical Examination Tests of Hip Specialists.

Key Findings

Clinical Relevance

Related Articles