Clinical Exam for Hip Pain

Hip pain can be difficult to assess. It could be coming from inside the joint or from structures outside the joint. Muscles, tendon, bursa, or capsule could be involved. The symptoms can even be referred to the hip from the sacrum, sacroiliac spine, or low back.

In this study, physical therapists evaluate the interrater reliability of four commonly used hip tests. Reliability tells us how consistently the test measures what it is supposed to measure. Interrater reliability shows how well the test measures results when used by different examiners.

The four tests included were FABER test, flexion-internal rotation-adduction impingement test, log roll test, and greater trochanter tenderness.

FABER stands for flexion, abduction, external rotation. It is the position the hip is placed in when the test is performed. The results help identify where the pain is coming from (hip, low back, sacroiliac joint). The impingement test combines hip motions that show if the labrum is getting pinched. The labrum is a rim of cartilage around the hip socket.

The log roll test is done with the patient lying on his or her back with the legs straight. The examiner holds the patient's heels and rolls the feet/legs in and out. This corresponds to motion within the hip and tests for ligament laxity (looseness).

The greater trochanter is the bony prominence of the hip felt along the outside of the hip area. Tenderness over this area is considered a sign of bursitis.

All patients included had hip pain as their primary symptom. Everyone was 18 years or older. All four tests were performed on each patient by both a physical therapist and an orthopedic surgeon. The tests were done within one hour of each other. The examiners did not know what results the other had recorded.

The results showed an acceptable level of interrater reliability for three of the four tests. The impingement test had low reliability. The next step in finding clinical tests that can be used to evaluate hip pain is to assess the validity of these tests.

This is done by comparing the test results with arthroscopic findings. Validity is a measure of how well the test accurately identifies a condition. The authors note that validity studies of these tests are currently underway.

Reference: 

Robroy L. Martin, PT, PhD, CSCS, and Jon K. Sekiya, MD. The Interrater Reliability of 4 Clinical Tests Used to Assess Individuals with Musculoskeletal Hip Pain. In Journal of Orthopaedic & Sports Physical Therapy. February 2008. Vol. 38. No. 2. Pp. 71-77.

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