Complexity of Hip Pain Diagnosis: Diagnosing hip pain is complex because many structures can be involved, and pain can refer from other areas (like the spine or pelvis).
Systematic Approach:
1. Rule out serious conditions (red flags): initial phase uses tests to identify potentially serious issues (e.g., fractures, infections, tumors) requiring immediate medical attention. The fulcrum test helps to assess for femoral neck stress fractures.
2. Rule out other pain generators: Tests are used to assess if the pain might originate from the lumbar spine or sacro-iliac pain: straight leg raise test, CROSS test
3. Focus on Intra-articular pathology (within the hip joint): Once serious conditions and other sources of pain are ruled out, the examination focuses on potential problems within the hip joint itself (e.g., labral tears, cartilage damage, femoroacetabular impingement (FAI)). Highly specific tests are used here. Tests for intra-articular pathology include the FADDIR test, the dial test, and the log roll test.
4. Impairments, Activity Limitations, Participation Restrictions: The final step assesses how the hip problem affects the athlete's daily life, including their physical function, activities, and participation in sports. This section involves range of motion assessments and muscle strength testing (often using manual muscle testing or hand-held dynamometry). The squeeze test is mentioned as a method of assessing hip adductor strength.
Diagnostic Tests and Imaging: various diagnostic tests (physical exam maneuvers, special tests), and imaging (X-rays, MRI, ultrasound, CT scans) are used to assess different aspects of the hip joint. Imaging alone shouldn't be relied upon for diagnosis.
Patient-Reported Outcome Measures (PROMs): Standardized questionnaires (PROMs) study how the hip condition impacts the quality of life and ability to participate in activities: International Hip Outcome Tool (iHOT), and the Copenhagen Hip and Groin Outcome Score (HAGOS).
