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What is the role of clinical tests and ultrasound in acetabular labral tear diagnostics?

Troelsen A, Mechlenburg I, Gelineck J, Bolvig L, Jacobsen S, Søballe K - Acta Orthop (2009)

Bottom Line: The impingement test had the best diagnostic ability of the clinical tests, with a sensitivity of 59% and a specificity of 100%.The positive predictive value was 100% while the negative predictive value was 13%.The impingement test is helpful in identifying acetabular labral tears.

View Article: PubMed Central - PubMed

Affiliation: Orthopaedic Research Unit, Aarhus University Hospital, Denmark. a_troelsen@hotmail.com

ABSTRACT

Background and purpose: An acetabular labral tear is a diagnostic challenge. Various clinical tests have been described, but little is known about their diagnostic sensitivity and specificity. We investigated the diagnostic validity of clinical tests and ultrasound as compared with MR arthrography.

Patients and methods: We examined 18 patients (18 hips, 2 men, median age 43 (32-56) years) with impingement test, FABER test, resisted straight leg raise test, ultrasound, and MR arthrography. They had had previous periacetabular osteotomies due to symptomatic, acetabular dysplasia. All hips showed no or only slight signs of osteoarthritis (Tönnis grade 0-1).

Results: MR arthrography identified labral tears in 17 of the 18 hips. Ultrasound had a sensitivity of 94%, a positive predictive value of 94%, and was false negative in only 1 case compared to MR arthrography. The impingement test had the best diagnostic ability of the clinical tests, with a sensitivity of 59% and a specificity of 100%. The positive predictive value was 100% while the negative predictive value was 13%.

Interpretation: The impingement test is helpful in identifying acetabular labral tears. If this test is negative and if a labral tear is still suspected, ultrasound can reliably diagnose most tears of the acetabular labrum. MR arthrography is indicated in cases where ultrasound is negative, but the patient suffers continued, specific symptoms.

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Related in: MedlinePlus

The impingement test was carried out by passively moving the hip joint in flexion (to 90°), internal rotation, and adduction. The test was regarded as being positive on reproduction of groin pain.
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Figure 0001: The impingement test was carried out by passively moving the hip joint in flexion (to 90°), internal rotation, and adduction. The test was regarded as being positive on reproduction of groin pain.

Mentions: In the impingement test the hip joint was passively flexed to 90˚, internally rotated, and adducted (Figure 1). In the FABER test the lower extremity was passively placed in a figure-of-four position, and slight pressure was applied to the medial side of the knee (Figure 2). In the resisted straight leg raise test, the patient actively flexed the hip joint to approximately 30˚ with extended knee. This position was held while the examiner applied a downward pressure (Figure 3). The patient’s response was registered as follows: (1) no pain; (2) groin pain; (3) anterior thigh pain; (4) posterior thigh pain; (5) lateral thigh pain; (6) pain in the buttock; (7) knee pain; (8) lumbarsacral or sacral-iliac pain; and (9) pain in other regions. A test was regarded positive by reproduction of groin pain.


What is the role of clinical tests and ultrasound in acetabular labral tear diagnostics?

Troelsen A, Mechlenburg I, Gelineck J, Bolvig L, Jacobsen S, Søballe K - Acta Orthop (2009)

The impingement test was carried out by passively moving the hip joint in flexion (to 90°), internal rotation, and adduction. The test was regarded as being positive on reproduction of groin pain.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2823204&req=5

Figure 0001: The impingement test was carried out by passively moving the hip joint in flexion (to 90°), internal rotation, and adduction. The test was regarded as being positive on reproduction of groin pain.
Mentions: In the impingement test the hip joint was passively flexed to 90˚, internally rotated, and adducted (Figure 1). In the FABER test the lower extremity was passively placed in a figure-of-four position, and slight pressure was applied to the medial side of the knee (Figure 2). In the resisted straight leg raise test, the patient actively flexed the hip joint to approximately 30˚ with extended knee. This position was held while the examiner applied a downward pressure (Figure 3). The patient’s response was registered as follows: (1) no pain; (2) groin pain; (3) anterior thigh pain; (4) posterior thigh pain; (5) lateral thigh pain; (6) pain in the buttock; (7) knee pain; (8) lumbarsacral or sacral-iliac pain; and (9) pain in other regions. A test was regarded positive by reproduction of groin pain.

Bottom Line: The impingement test had the best diagnostic ability of the clinical tests, with a sensitivity of 59% and a specificity of 100%.The positive predictive value was 100% while the negative predictive value was 13%.The impingement test is helpful in identifying acetabular labral tears.

View Article: PubMed Central - PubMed

Affiliation: Orthopaedic Research Unit, Aarhus University Hospital, Denmark. a_troelsen@hotmail.com

ABSTRACT

Background and purpose: An acetabular labral tear is a diagnostic challenge. Various clinical tests have been described, but little is known about their diagnostic sensitivity and specificity. We investigated the diagnostic validity of clinical tests and ultrasound as compared with MR arthrography.

Patients and methods: We examined 18 patients (18 hips, 2 men, median age 43 (32-56) years) with impingement test, FABER test, resisted straight leg raise test, ultrasound, and MR arthrography. They had had previous periacetabular osteotomies due to symptomatic, acetabular dysplasia. All hips showed no or only slight signs of osteoarthritis (Tönnis grade 0-1).

Results: MR arthrography identified labral tears in 17 of the 18 hips. Ultrasound had a sensitivity of 94%, a positive predictive value of 94%, and was false negative in only 1 case compared to MR arthrography. The impingement test had the best diagnostic ability of the clinical tests, with a sensitivity of 59% and a specificity of 100%. The positive predictive value was 100% while the negative predictive value was 13%.

Interpretation: The impingement test is helpful in identifying acetabular labral tears. If this test is negative and if a labral tear is still suspected, ultrasound can reliably diagnose most tears of the acetabular labrum. MR arthrography is indicated in cases where ultrasound is negative, but the patient suffers continued, specific symptoms.

Show MeSH
Related in: MedlinePlus