File
Caliesch R1, Hilfiker R2
1Bern University of Applied Sciences, Department of Health Professions, Bern, Switzerland, 2University of Applied Science and Arts of Western Switzerland, Leukerbad, Switzerland
Background: Femoroacetabular Impingement (FAI) syndrome is seen as a predisposing factor for degenerative processes in the hip joint. Recognition and adequate intervention is needed to reduce the risk of premature degeneration and the onset of arthritis. Several clinical tests for the diagnosis of FAI morphologies are proposed, but there is a lack of an actual systematic overview of the current literature about the accuracy of these tests.
Purpose: To examine the diagnostic accuracy of clinical tests and Ultrasound for pincer, cam or mixed type deformities in people with FAI syndrome, and discussing the clinical utility of these tests.
Methods: A systematic search of MEDLINE via PubMed, CINAHL, EMBASE and SPORTDiscus databases was conducted. Due to a lack of data, a meta-analysis was not performed and results were analysed in a descriptive manner. Changes of pre-test probabilities depending on varying prevalence were presented. A test combination was proposed based on available LR and the use of a Fagan Nomogram.
Results: Eight studies were included, investigating 19 clinical tests. Overall results showed a low specificity for all tests, ranging from 0.11 to 0.44. Sensitivity was moderate for pain provocation tests and imaging per Ultrasound, ranging from 0.56 to 1.00. A combination of four selected tests (FADIR, Ultrasound, FPAW and maximal Squat Test) with a negative test result showed a negative LR of 0.12.
Conclusion(s): Clinical tests and Ultrasound might be used to cautiously reduce the probability of pincer or cam deformities. Especially the consecutive testing of FADIR, Ultrasound, FPAW and maximal Squat test might be used as a clinical test combination. Due to the low specificity of tests, we would not recommend to use these tests to confirm a diagnosis. These conclusions are based on few studies, with high risk of bias and overall low quality level of evidence.
Implications: The current literature indicates that clinical tests and Ultrasound are not appropriate to rule in a cam or pincer deformity, but pain provocation tests and Ultrasound can potentially be used to rule out a diagnosis of FAI deformity with a negative test result.
Keywords: Femoroacetabular impingement, diagnostic accuracy
Funding acknowledgements: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Purpose: To examine the diagnostic accuracy of clinical tests and Ultrasound for pincer, cam or mixed type deformities in people with FAI syndrome, and discussing the clinical utility of these tests.
Methods: A systematic search of MEDLINE via PubMed, CINAHL, EMBASE and SPORTDiscus databases was conducted. Due to a lack of data, a meta-analysis was not performed and results were analysed in a descriptive manner. Changes of pre-test probabilities depending on varying prevalence were presented. A test combination was proposed based on available LR and the use of a Fagan Nomogram.
Results: Eight studies were included, investigating 19 clinical tests. Overall results showed a low specificity for all tests, ranging from 0.11 to 0.44. Sensitivity was moderate for pain provocation tests and imaging per Ultrasound, ranging from 0.56 to 1.00. A combination of four selected tests (FADIR, Ultrasound, FPAW and maximal Squat Test) with a negative test result showed a negative LR of 0.12.
Conclusion(s): Clinical tests and Ultrasound might be used to cautiously reduce the probability of pincer or cam deformities. Especially the consecutive testing of FADIR, Ultrasound, FPAW and maximal Squat test might be used as a clinical test combination. Due to the low specificity of tests, we would not recommend to use these tests to confirm a diagnosis. These conclusions are based on few studies, with high risk of bias and overall low quality level of evidence.
Implications: The current literature indicates that clinical tests and Ultrasound are not appropriate to rule in a cam or pincer deformity, but pain provocation tests and Ultrasound can potentially be used to rule out a diagnosis of FAI deformity with a negative test result.
Keywords: Femoroacetabular impingement, diagnostic accuracy
Funding acknowledgements: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Topic: Musculoskeletal: lower limb
Ethics approval required: No
Institution: Bern University of Applied Sciences, Department of Health Professions, Switzerland
Ethics committee: not applicable
Reason not required: no ethics approval needed for a systematic review
All authors, affiliations and abstracts have been published as submitted.
