Diagnostics accuracy of clinical
tests for the diagnosis of hip femoroacetabular impingement/labral tear: a
systematic review with meta-analysis

MP, Goode AP, Cook CE, Holmich P, & Thorborg K. Br J Sports Med.2014, 0:1-12. E pub ahead of print December 16,

Take Home Message: There are many
clinical special tests geared towards diagnosing labral tears and femoroacetabular
impingement.  Unfortunately, these tests
are largely not helpful in confirming the presence of the pathology in
population that is likely to have either.

Hip surgery is becoming a common
strategy to correct femoroacetabular impingement and labral pathologies.  Diagnosing these conditions can be
challenging and there is interest around developing cost-effective and accurate
clinical tests for diagnosis of these hip pathologies.  The authors of this systematic review aimed
to evaluate the diagnostic accuracy of hip physical examination tests.  They identified 21 papers, which consisted of
1335 participants and 11 different clinical special tests.  There were a sufficient number of studies for
a meta-analysis to investigate only two of the 11 tests: flexion adduction and
internal rotation (FADDIR) as well as flexion internal rotation test. Eight of
the included studies were retrospective, 9 were prospective, and the study
design was unknown for 4 studies.  The
reported FADDIR sensitivity averages ranged from 56 to 100% and specificity
ranged from 6 to 83% for all of the studies. 
For flexion-internal rotation tests the sensitivity averages ranged from
70 to 98% while the specificity ranged from 8 to 44% for all of the studies.  The pooled meta-analysis results indicated
that FADDIR sensitivity was 94 to 99% while specificity ranged from 5 to 9%;
and for the flexion-internal rotation test the sensitivity was 96% and
specificity was 25%.  Most clinical
special tests yielded at best a marginal increase in the probability of
correctly diagnosing the pathology.    

overall accuracy of clinical hip special tests is poor and this study
highlights that their clinical helpfulness is minimal when there is a high
suspicion of hip pathology.  The two clinical
tests in the meta-analysis and many of the other tests could not correctly
identify people without hip pathology when the test was negative. The “gold
standard” in these studies was either surgery or MR-arthrogram.  This meta-analysis investigated the use of
any one clinical special test in improving diagnostic accuracy.  It may be of value to try to determine what
signs or symptoms in addition to a combination of special tests helps to
accurately diagnose
impingement or labral pathology.  In conclusion, these clinical tests do not
add much value to diagnosis and need to be interpreted carefully.  The clinical presentation and patient history
may be more beneficial when trying to differentiate a diagnosis, but this needs
to be further examined. 

Questions for Discussion:  What
combination of clinical tests do you use to help to rule out or in
impingement or
labral tear?  Are there any clinical
findings that you anecdotally are finding to help with your diagnostic

Nicole Cattano
by: Jeffrey Driban

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Helpful Information:

Reiman, M., Goode, A., Cook, C., Holmich, P., & Thorborg, K. (2014). Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: a systematic review with meta-analysis British Journal of Sports Medicine DOI: 10.1136/bjsports-2014-094302