Physical examination tests for the diagnosis of femoroacetabular impingement. A systematic review

Abstract

Numerous clinical tests have been proposed to diagnose FAI, but little is known about their diagnostic accuracy.

Objectives: To summarize and evaluate research on the accuracy of physical examination tests for diagnosis of FAI.

Methods: A search of the PubMed, SPORTDiscus and CINAHL databases was performed. Studies were considered eligible if they compared the results of physical examination tests to those of a reference standard. Methodological quality and internal validity assessment was performed by two independent reviewers using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool.

Results: The systematic search strategy revealed 298 potential articles, five of which articles met the inclusion criteria. After assessment using the QUADAS score, four of the five articles were of high quality. Clinical tests included were Impingement sign, IROP test (Internal Rotation Over Pressure), FABER test (Flexion-Abduction-External Rotation), Stinchfield/RSRL (Resisted Straight Leg Raise) test, Scour test, Maximal squat test, and the Anterior Impingement test. IROP test, impingement sign, and FABER test showed the most sensitive values to identify FAI.

Conclusions: The diagnostic accuracy of physical examination tests to assess FAI is limited due to its heterogenecity. There is a strong need for sound research of high methodological quality in this area.

Keywords: Diagnostic accuracy; Femoroacetabular impingement; Hip pain; Physical examination.