Top Contributors - Sheik Abdul Khadir, Marlies Verbruggen, Adam Vallely Farrell, Kim Jackson, WikiSysop, Vidya Acharya, Wanda van Niekerk, Melissa Decoen and Evan Thomas. Orthofixar does not endorse any treatments, procedures, products, or physicians referenced herein. Data Sources: We searched articles on hip pathology in American Family Physician, along with their references. Magnetic resonance arthrography is the diagnostic test of choice for labral tears. That is usually the journal article where the information was first stated. The pain usually has an insidious onset, but occasionally begins acutely after a traumatic event. Magnetic resonance imaging should be used for detection of occult hip fractures, stress fractures, and osteonecrosis of the femoral head. Osteoarthritis is the most likely diagnosis in older adults with limited motion and gradual onset of symptoms. The Piriformis test is a lower limb provocation test to evaluate the impact of the piriformis muscle on the sciatic nerve. Magnetic resonance imaging should be performed if the history and plain radiograph results are not diagnostic. Clinical Journal of Sport Medicine. [1], The premise of this test is that flexion and adduction motions approximates the femoral head with the acetabular rim. My name is Anas and I am physiotherapist (physio). This nerve enters the gluteal region inferiorly to the piriformis.If the lateral rotators of the hip are tight they may exert pressure on the sciatic nerve, producing pain radiating into the lower extremity[1][3].This is known asPiriformis Syndrome. The people with the worst FAI bone shapes didnt even have pain on the FADIR test. Pain is sharp when turning or pivoting, especially toward the affected side. Another group of clinicians assessed their X-rays for signs of FAI. For more detailed information on the anatomy of the piriformis muscle. The doctor then adducts and internally rotates the hip. For example, people of Papua, New Guinea have the ability to remember names of about 10,000 to 20,000 clans. Now you might be thinking, "okay, the FADIR test is apparently not good. and B.J. Diagnostic accuracy of clinical tests for cam or pincer morphology in individuals with suspected FAI syndrome: a systematic review. Patients with refractory cases should be referred to an orthopedic sub-specialist for consideration of arthroscopy. Femoroacetabular impingement (FAI) syndrome is a motion-related clinical disorder of the hip involving premature contact between the acetabulum and the proximal femur, which results in particular symptoms, clinical signs and imaging findings. Translation: FADIR isnt reliable for predicting abnormal bone shapes. They found no strong correlations between bone shapes, the hip impingement test, and hip pain. Copyright 2009 by the American Academy of Family Physicians. And it was only able to accurately identify FAI bone shapes 9% of the time. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. The FADIR had a 40% false positive rate. of the FADIR test in patients with FAI were recorded. A group of clinicians assessed them on ROM tests. They compared the FADIR outcomes to MRIs from 74 youth male ice hockey players. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Treatment often requires arthroscopy, which typically allows patients to resume premorbid physical activities. When you look deeper, you discover that NONE of the tests for hip impingement work - and that theres very little evidence for the entire theory! The FADIR test, consists of flexion, adduction, and internal rotation that results in pain or clicking. The FAIR test correlates well with a working definition of piriformis syndrome, based on prolongation of the H-reflex with hip flexion, adduction, and internal rotation (FAIR) and is a better predictor of successful physical therapy and surgery than the working definition. If you have hip pain and are wondering if there are good tests for femoroacetabular impingement that will tell you if you have FAI, you may found a number of common tests that are believed to be reliable. Results: Anterior impingement test (AIMT), FADIR test and FABER test showed kappa values above 0.6. Action: Do not allow patient to move pelvis forward or backward. If a labral lesion is present, forcing the movement combination of hip flexion, abduction, and internal rotation will lead to pain due to contact of the femoral neck with the anterolateral acetabular rim (impingement test). Enter your name and email for INSTANT ACCESS tomyonline video course! Caliesch R, Sattelmayer M, Reichenbach S, Zwahlen M, Hilfiker R. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. Below you will find a list of hip special tests and links to each test with description and video if available. The athletes had ages between 13-20 years old. The examiner places the tested hip in full flexion, then induces an adduction movement combined with internal rotation. Whether arthroscopic treatment prevents or delays osteoarthritis of the hip is unknown. We use practical, safe, and effective exercises to build confidence and resilience. Slowly release the patient's leg while stabilizing the pelvis. While that may seem like a big claim, it's based onfindings in high quality research studies for shoulders and the spine. In a 2010 study looking at the validity of hip pain tests,researchers found that theFABER test had aspecificity of only 25%. The doctor then adducts and internally rotates the hip. In current medical practice, the diagnostic process for femoroacetabular impingement relies on: There are major issues with both of these components. Abduct leg as far as possible, knee extended and extend hip. Injured labral tissue is repaired or debrided. Using a test like this to convince someone to get surgery is misguided at best and irresponsible at worst. 2023 Lineage Medical, Inc. All rights reserved, Discoloration, wounds, or gross deformity, Position - internally or externally rotated; flexion contractures, Observe the stride length, foot rotation, pelvic rotation, stance phase, weight bearing on the affected hip leads to a contralateral hip drop, Pain can be attributable to bursitis, tendonitis, infection, or fracture, pain with hamstring avulsions / tendinopathy, pain with oblique avulsions / hip pointers, proximal anteromedial thigh - genitofemoral nerve, lateral thigh - lateral femoral cutaneous nerve, posterior thigh - posterior femoral cutaneous nerve, positive test if patient has hip or groin pain, positive test if patient has hip or back pain or ROM is limited, can suggest intra-articular hip lesions, iliopsoas pain, or sacroiliac disease (posteriorly located pain), passive maximal internal and external rotation of lower extremity while supine, clicking or popping suggest acetabular labral tear, increased total ROM compared to contralateral side suggests ligament or capsular laxity, if contralateral hip lifts off table, there is likely a fixed flexion deformity, patient placed in lateral position with affected side up, with hip in slight extension, abduct the leg then allow it to drop into adduction, if unable to adduct leg, suspect tight ITB, with patient supine and extended knee, examiner resists active hip flexion past 30-45 deg, a positive test ellicits pain which is likely to be associated with an intraarticular hip pathology, Arthroplasty Preoperative Medical Optimization, Idiopathic Transient Osteoporosis of the Hip (ITOH), THA Pseudotumor (Metal on Metal Reactions), TKA Postoperative Rehabilitation & Outpatient Management. The consent submitted will only be used for data processing originating from this website. The problem is that most people consult only when their pain becomes intolerable. It injures the labrum and articular cartilage, and can lead to osteoarthritis of the hip if left untreated. However, studies show an increased risk of osteoarthritis in patients with FAI. Theres a catch, though. In either case, this article is going to cover something medical literature on FAI overlooks: the tests for hip pain causes are wildly unreliable. That is the simplest, least invasive, and natural means to reclaiming your life. Femoroacetabular impingement syndrome (FAIS) describes hip-related groin pain due to pathological contact between the femoral head-neck junction and the acetabular rim during a functional range of hip movement. Clinical Tests for the Musculoskeletal System, Third Edition. We and our partners use data for Personalised ads and content, ad and content measurement, audience insights and product development. Elsevier. Flexion, Adduction, Internal Rotation test refers to a clinical examination test performed to assess for hip f emoroacetabular impingement.. If in doubt, it is always best to consult. Eventually, noticeable apprehension also leads to a positive test. The FAIR test is a sensitive and specific test for detection if irritation of the sciatic nerve by the piriformis. The articular surfaces are covered by hyaline cartilage that dissipates shear and compressive forces during load bearing and hip motion. How useful is the flexionadductioninternal rotation test for diagnosing femoroacetabular impingement: a systematic review. Benzon HT, Katz JA, Benzon HA, Iqbal MS. Piriformis syndrome: anatomic considerations, a new injection technique and a review of the literature. We also searched the Agency for Healthcare Research and Quality Evidence Reports, Clinical Evidence, Institute for Clinical Systems Improvement, the U.S. Preventive Services Task Force guidelines, the National Guideline Clearinghouse, and UpToDate. Then the hip is hyper flexed, internally rotated, and adducted. You could have a positive sign of hip impingement but no X-ray evidence of FAI. Patients with FAI typically have anterolateral hip pain. Magee DJ. The patient should keep a pain diary for four days after the injection; relief of pain confirms an intra-articular origin of pain. A history and physical examination are essential to accurately diagnose the cause of hip pain. The FADIR test (flexion, adduction, internal rotation; Figure 4), log roll test , and straight leg raise against resistance test are also effective, with sensitivities of 88%, 56%, and 30% . It is part of the lateral rotators of the hip (obturator internus, superior and inferior gemelli, quadratus femoris, obturator externus, andgluteus maximus). FAIR test is in <60 degrees of flexion "Take of shoe test" for proximal hamstring strain in standing remove shoe off injured leg with uninjured leg Physical performance tests for non-arthritic hip pain stepdown test single leg squat star excursion balance test (SEBT) Physical performance tests for hip OA Evaluate Piriformis muscle and other causes of hip pain Description The patient can be either supine or laying on their side Passively move their hip into 90 of flexion, while adducting and internally rotating Positive test Is a positive femoroacetabular impingement test a common finding in healthy young adults?. Clinical orthopaedics and related research vol. This impingement causes lesions of the acetabular labrum and joint cartilage, especially in young and physically active individuals, who clinically experience groin pain when sitting and when involved in sports activities. Questions related to hip function, such as the ease of getting in and out of a car, putting on shoes, running, walking, and going up and down stairs, can be helpful.3 Location of the pain is informative because hip pain often localizes to one of three basic anatomic regions: the anterior hip and groin, posterior hip and buttock, and lateral hip (eFigure A). Tread carefully. are positive). Posterior hip pain is associated with piriformis syndrome, sacroiliac joint dysfunction, lumbar radiculopathy, and less commonly ischiofemoral impingement and vascular claudication. That sequence of movements smashes the labrum and causes pain. Adduct the hip with combined Internally rotation of the hip. That's why doctors use both to examine the cause of hip pain for their patients!". Lori A, Boyajian- O Neill et al. 2014. The FADIR test (flexion, adduction, internal, rotation) is used for the examination of Femoroacetabular impingement syndrome, anterior labral tear and iliopsoas tendinitis. 471,7 (2013): 2267-77. doi:10.1007/s11999-013-2850-9. THE FABER TESTHAS A VERY HIGHRISK OF FALSE POSITIVES. About one-half of patients with this injury also have mechanical symptoms, such as catching or painful clicking with activity.17 The FADIR and FABER tests are effective for detecting intra-articular pathology (the sensitivity is 96% to 75% for the FADIR test and is 88% for the FABER test), although neither test has high specificity.14,15,18 Magnetic resonance arthrography is considered the diagnostic test of choice for labral tears.6,19 However, if a labral tear is not suspected, other less invasive imaging modalities, such as plain radiography and conventional MRI, should be used first to rule out other causes of hip and groin pain. Passive hip ROM in internal rotation with neutral hip position had a . They had an average playing experience of 11 2 years. Hip pain is a common presentation in primary care and can affect patients of all ages. If concern for FAI persists, magnetic resonance arthrography is recommended to evaluate the labrum. The examined leg is passively flexed in knee and hip joints at 90 degrees. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. With the patient supine with one leg extended, flex, adduct, and internally rotate the hip. {"url":"/signup-modal-props.json?lang=us"}, Kecler-Pietrzyk A, Sheikh Y, FADIR test. These players did not have hip pain. FAI can begin in adolescence or adulthood. BMJ open sport & exercise medicine. These movements, when combined, induce contact between the femoral neck and the rim of the acetabulum. The FADIR test is the most sensitive physical examination test for FAI. Clinical examination tests, although helpful, are not highly sensitive or specific for most diagnoses; however, a rational approach to the hip examination can be used. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. We have multiple muscles that attach in the groin and can easily be smashed, pinched, overworked, or just plain annoyed to speak NOTHING of a labrum. [. The FAIR test is a sensitive and specific test for detection if irritation of the sciatic nerve by the piriformis. The examined leg is passively flexed in knee and hip joints at 90 degrees. The FAIR test can be performed with the patient supine or seated, knee and hip flexed, and hip medially rotated, while the patient resists examiner attempts to externally rotate and abduct the hip. However, a combination of both forms is most frequently encountered. In those who are skeletally mature, hip pain is often a result of musculotendinous strain, ligamentous sprain, contusion, or bursitis. It is used by healthcare professionals to diagnose certain hip pathologies such as: The term "FADIR" is an acronym that designates the movements of flexion (F), adduction (AD) and internal rotation (IR) of the hip. Radiography. Sometimes the patient will feel pain behind the buttock or along the thigh. 2020 Jan 1;30(1):76-82. Short answer: FADIR is NOT reliable as a hip impingement test. All Rights Reserved. https://www.physio-pedia.com/Anterior_Labral_Tear_Test_(Flexion,_Adduction,_and_Internal_Rotation)_FADDIR_TEST, https://fpnotebook.com/ortho/exam/FdrTst.htm, https://www.researchgate.net/figure/Patient-passively-placed-in-full-hip-fl-exion-adduction-and-internal-rotation-for-the_fig6_260377851. Reiman et al. In recent years, notable progress has been made in the diagnosis and treatment of nonarthritic hip injuries. Description. A positive test occurs when pain is produced in the sciatic/gluteal area. The medical community is barking up the wrong tree. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. The performance of special tests for the hip with the intention of diagnosing or . There are no published studies of nonsurgical treatment of FAI. This self-paced video course will teach youtechniques that willsave you thousands of dollars in massage and chiropractic appointments! The apophysis of the superior iliac spine matures last and is susceptible to injury up to 25 years of age.2. The hip examination should evaluate the hip, back, abdomen, and vascular and neurologic systems. Description Patient stays supine. Patient information: See related handout on hip pain, written by the authors of this article. We and our partners use cookies to Store and/or access information on a device. And a 9% true positive rate. Clinically Relevant Anatomy The piriformis is a flat muscle and the most superficial muscle of the deep gluteal muscles. The hip pain test results just didn't match up to anything. David J. Magee. Performing the Test: The patient's tested leg is placed in a "figure-4" position, where the knee is flexed and the ankle is placed on the opposite knee. To alleviate impingement, pincer and cam lesions are removed and femoral offset is corrected, restoring bony alignment (Figure 6). The real answer is to learn how to retrain your muscles for proper motion and function. Conventional magnetic resonance imaging (MRI) of the hip can detect many soft tissue abnormalities, and is the preferred imaging modality if plain radiography does not identify specific pathology in a patient with persistent pain.5 Conventional MRI has a sensitivity of 30% and an accuracy of 36% for diagnosing hip labral tears, whereas magnetic resonance arthrography provides added sensitivity of 90% and accuracy of 91% for the detection of labral tears.6,7, Ultrasonography. Radiography should be performed in patients in whom the history and physical examination are consistent with FAI. It is important to know that FAI is very often an asymptomatic finding and altered hip anatomy does not necessarily lead to symptoms even in athletes. Hockey is a high impact, highly demanding sport for the hips. 2015 Jun 1;49(12):811-. Pace JB, Nagle D. Piriformis syndrome. The prevalence of cam morphology is reported to range between 45% and 75% in ice hockey players. The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network. It is hypothesized that arthroscopic treatment of FAI can prevent or delay the onset or progression of osteoarthritis of the hip, but this has yet to be demonstrated with long-term clinical follow-up. Femoroacetabular impingement, also known as hip impingement, is the abutment of the acetabular rim and the proximal femur. From the total of 68 hip joints, 64 (94% of them!) That's10 false negatives. Anterior hip and groin pain is commonly associated with intra-articular pathology, such as osteoarthritis and hip labral tears. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. Passively move the patient's lower extremity into flexion (90 degrees), adduction, and internal rotation. Test Position: Supine. FADIR test hip Flexed to 90 deg, ADducted and Internally Rotated positive test if patient has hip or groin pain can suggest possible labral tear or FAI FABER test (aka Patrick's test) hip Flexed to 90 deg, ABducted and Externally Rotated positive test if patient has hip or back pain or ROM is limited Even more simply: FADIR was pointless. Lateral hip pain occurs with greater trochanteric pain syndrome. The hip has a large range of motion in all planes, and is stabilized by a capsule, the surrounding muscles, and the labrum, which is a wedge-shaped cartilage structure that deepens the acetabulum and cushions the joint.1, The differential diagnosis of hip pain is broad and includes conditions of the hip, lower back, and pelvis (Table 1). Four hundred fifty-two patients (622 hips) with a mean age of 27.0 9.0 were examined. The FADIR test along with the Foot Progression Angle Walking (FPAW) test and the maximal squat test were found to have the best sensetivities for FAI. Concurrent criterion-related validity of physical examination tests for hip labral lesions: a systematic review. In prepubescent and adolescent patients, congenital malformations of the femoroacetabular joint, avulsion fractures, and apophyseal or epiphyseal injuries should be considered. The journal of the American and osteopathic association Nov 2008; 108(11): 657-664. Unable to process the form. Ideally our tests should catch all the cases of a disease and identify all the cases where a disease is NOT present. The goals of arthroscopy are to alleviate impingement, to repair or remove injured tissue, and to prevent or delay osteoarthritis. 08/25/2012. High rates of false positives and false negatives make a test less useful and less reliable. These movements, when combined, induce contact between the femoral . The piriformis is a flat muscle and the most superficial muscle of the deep gluteal muscles. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. This can direct the health professional towards a disorder of the sciatic nerve, or a piriformis syndrome. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). The hip is a ball-and-socket joint in which the articular surfaces of the femoral head and the acetabulum are lined with articular cartilage (Figure 1). [4], Another systematic review found the FADIR test to have high sensetivity of 0.96 and low specificity of 0.11. The patient's leg is flexed to 90, adducted and additionally positioned in internal rotation. J Bone Joint Surg2002; 84-B: 104-107. Technique: Flexion, ADduction and Internal Rotation (F-Ad-Ir) Patient supine. Interactive Content (Direct Video Demonstration, PubMed articles), Statistical Values for all Special Tests from the latest research, Currently on Version 6.0 Free lifetime updates. Special tests produce pain (i.e. Examiner raises one leg with hip flexed to 90 degrees and knee flexed to 90 degrees. Because standard AP and lateral views of the hip can miss important abnormalities in patients with FAI, modified Dunn view radiography, in which the hip is flexed 90 degrees and abducted 20 degrees (Figure 5), should be ordered.11 This view is highly sensitive for detecting cam lesions and osteophytes on the anterior femoral neck.11. Continue with Recommended Cookies, Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine. Magnetic resonance imaging is valuable for the detection of occult traumatic fractures, stress fractures, and osteonecrosis of the femoral head. In most cases Physiopedia articles are a secondary source and so should not be used as references. is proximal to) the opposite (or contralateral) knee. Pain with insidious onset that is worse with weight bearing; recent trauma or corticosteroid use, Surgery or close observation by an orthopedic surgeon, Hip pain with exercise or direct pressure, Tender bursa over greater trochanter or iliopsoas tendon; may accompany intra-articular hip pathology, Usually none; MRI or ultrasonography can confirm, Physical therapy, corticosteroid injection; arthroscopic debridement if refractory, Fever, night sweats, night pain, weight loss, history of cancer, Soft tissue mass near hip (e.g., sarcoma), pelvic mass, lumbar radiculopathy (if lumbar tumor), Radiography, CT (hip, pelvis, or lumbar spine, depending on suspected location), Hernia palpated in inguinal or femoral canal, Severe pain with recent onset, difficulty moving the hip, recent surgery, intravenous drug use, Radiography, complete blood count, erythrocyte sedimentation rate, joint aspiration, Joint aspiration and irrigation, antibiotics, Hip pain with exercise; recent trauma or overuse, Hip pain with log roll or Patrick (FABER) test, Radiography, magnetic resonance arthrography, Lumbar spine pathology (e.g., T12-L2 disk herniation, degenerative disease), Pain with walking or prolonged sitting; possible numbness, tingling, or weakness in lower extremities, Limited lumbar motion; normal hip examination; sensory or motor abnormalities in lower extremities; positive straight leg raise (possibly), Pain early in exercise, recent increase in exercise, Tender muscle, pain with stretching and with resistance of the affected muscle, Pain radiating to the groin, stiffness, age older than 40 years, Pain with hip rotation or Patrick (FABER) test, limited range of motion late in disease process, Physical therapy, analgesics, surgical hip replacement or resurfacing if refractory, Pelvic pathology (e.g., endometriosis, ovarian mass, colon cancer), Ultrasonography, CT, endoscopy, or laparoscopy as indicated, Asymmetry suggests SI joint dysfunction or leg-length discrepancy, either of which can cause SI joint pain, pubic symphysis pain, or muscle strain, Tenderness indicates that tissue is involved. Main results: Eight studies of levels III (87.5%) and IV (12.5%) evidence were included. Other common orthopedic tests to assess for FAI and/or labrum tears of the hip are: document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Reiman MP, Goode AP, Cook CE, Hlmich P, Thorborg K. Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: a systematic review with meta-analysis. 6th edition. Pain may improve with physical therapy. Obesity, pregnancy, tight pants or belt, conditions with increased intra-abdominal pressure, Dull, diffuse pain radiating to inner thigh; pain with direct pressure, sneezing, sit-ups, kicking, Valsalva maneuver, No hernia, tenderness of the inguinal canal or pubic tubercle, adductor origin, pain with resisted sit-up or hip flexion, MRI: Can show tear or detachment of the rectus abdominis or adductor longus, Deep, referred pain; pain with weight bearing, Females (especially with female athlete triad), endurance athletes, low aerobic fitness, steroid use, smokers, Painful ROM, pain on palpation of greater trochanter, Deep, referred pain; pain with standing after prolonged sitting, Radiography: Cam or pincer deformity, acetabular retroversion, coxa profunda, Dull or sharp, referred pain; pain with weight bearing, Mechanical symptoms, such as catching or painful clicking; history of hip dislocation, Trendelenburg or antalgic gait, loss of internal rotation, positive FADIR and FABER tests, Magnetic resonance arthrography: offers added sensitivity and specificity, Iliopsoas bursitis (internal snapping hip), Deep, referred pain; intermittent catching, snapping, or popping, Snap with FABER to extension, adduction, and internal rotation; reproduction of snapping with extension of hip from flexed position, MRI: Bursitis and edema of the iliotibial band, Ultrasonography: Tendinopathy, bursitis, fluid around tendon, Dynamic ultrasonography: Snapping of iliopsoas or iliotibial band over greater trochanter, Radiography: Early small femoral epiphysis, sclerosis and flattening of the femoral head, Mechanical symptoms, history of hip dislocation or low-energy trauma, history of Legg-Calv-Perthes disease, Limited ROM, catching and grinding with provocative maneuvers, positive FADIR and FABER tests, Radiography: Can show ossified or osteochondral loose bodies, MRI: Can detect chondral and fibrous loose bodies, Deep, aching pain and stiffness; pain with weight bearing, Older than 50 years, pain with activity that is relieved with rest, Internal rotation < 15 degrees, flexion < 115 degrees, Radiography: Presence of osteophytes at the acetabular joint margin, asymmetrical joint-space narrowing, subchondral sclerosis and cyst formation, Adults: Lupus, sickle cell disease, human immunodeficiency virus infection, corticosteroid use, smoking, and alcohol use; insidious onset, but can be acute with history of trauma, Pain on ambulation, positive log roll test, gradual limitation of ROM, Radiography: Femoral head lucency and subchondral sclerosis, subchondral collapse (i.e., crescent sign), flattening of the femoral head, 11 to 14 years of age, overweight (80th to 100th percentile), Antalgic gait with foot externally rotated on occasion, positive log roll and straight leg raise against resistance tests, pain with hip internal rotation relieved with external rotation, Radiography: Widened epiphysis early, slippage of femur under epiphysis later, Refusal to bear weight, pain with leg movement, Children: 3 to 8 years of age, fever, ill appearance, Guarding against any ROM; pain with passive ROM, Hip aspiration guided by fluoroscopy, computed tomography, or ultrasonography; Gram stain and culture of joint aspirate, MRI: Useful for differentiating septic arthritis from transient synovitis, Children: 3 to 8 years of age, sometimes fever and ill appearance, Pain with direct pressure, radiation down lateral thigh, snapping or popping, All age groups, audible snap with ambulation, Positive Ober test, snap with Ober test, pain over greater trochanter, Pain with direct pressure, radiation down lateral thigh, Associated with knee osteoarthritis, increased body mass index, low back pain; female predominance, Proximal iliotibial band tenderness, Trendelenburg gait is sensitive and specific, Pain with direct pressure, radiation down lateral thigh and buttock, Weak hip abduction, pain with resisted external rotation, Trendelenburg gait is sensitive and specific, History of direct trauma, skeletal immaturity (younger than 25 years), Radiography: Apophysis widening, soft tissue swelling around iliac crest, Eccentric muscle contraction while hip flexed and leg extended, Ischial tuberosity tenderness, ecchymosis, weakness to leg flexion, palpable gap in hamstring, Radiography: Avulsion or strain of hamstring attachment to ischium, Buttock or back pain with posterior thigh radiation, sciatica symptoms, Groin and/or buttock pain that may radiate distally, MRI: Soft tissue edema around quadratus femoris muscle, Buttock pain with posterior thigh radiation, sciatica symptoms, History of direct trauma to buttock or pain with sitting, weakness and numbness are rare compared with lumbar radicular symptoms, Positive log roll test, tenderness over the sciatic notch, MRI: Lumbar spine has no disk herniation, piriformis muscle atrophy or hypertrophy, edema surrounding the sciatic nerve, Pain radiates to lumbar back, buttock, and groin, Female predominance, common in pregnancy, history of minor trauma, FABER test elicits posterior pain localized to the sacroiliac joint, sacroiliac joint line tenderness, Radiography: Possibly no findings, narrowing and sclerotic changes of the sacroiliac joint space, Antalgic gait, Trendelenburg gait, pelvic wink (rotation of more than 40 degrees in the axial plane toward the affected hip when terminally extending the hip), excessive pronation or supination of the ankles, and limps caused by differing leg lengths, Hip labral tear, transient synovitis, Legg-Calv-Perthes disease, SCFE, 2-cm drop in the level of the iliac crest, indicating weakness on the contralateral side, Pain with passive ROM: Transient synovitis, septic arthritis, Limited ROM: Loose bodies, chondral lesions, osteoarthritis, Legg-Calv-Perthes disease, osteonecrosis, Posterior pain localized to the sacroiliac joint, lumbar spine, or posterior hip; groin pain with the test is sensitive for intra-articular pathology, Hip labral tear, loose bodies, chondral lesions, femoral acetabular impingement, osteoarthritis, sacroiliac joint dysfunction, iliopsoas bursitis, Hip labral tear, loose bodies, chondral lesions, femoral acetabular impingement, Straight leg raise against resistance test (, Athletic pubalgia (sports hernia), SCFE, femoral acetabular impingement, Passive adduction past midline cannot be achieved, External snapping hip, greater trochanteric pain syndrome.
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