Clinical Examination of Hip Dysplasia/Instability

Clinical examination is one of the main skill that clinicians acquire through training and experience, and its contribution to diagnosis is a key addition to history taking. Mike Reiman is a physical therapist, author of the excellent textbook «Orthopedic clinical examination», who just conpleted his PhD (congrats!) under the supervision of Kristian Thorborg (Denmark), looking at the validity of the most frequently used clinical examination tests around the hip area. We tend to think that “specialized” tests have great significance for the examination of a particular structure of pathology, yet as we have already learned from multiple studies on this very question around the shoulder examination tests, this is deceptive. In this article, Dr Reiman looks at what we know for hip instability tests, and the conclusion is not very different. Some tests can help in ruling in a pathology (higher specificity than sensibility), but should by no means be considered decisive. At #SportSuisse2018, he presented his PhD work on femoro-acetabular impingement tests, and the findings are not dissimilar to this article. We should be very careful with the interpretation we make of positive clinical tests. First, the tests should be properly standardized and executed. Second, the clinician must understand when a test is to be interpreted as positive: do we look for pain (reproduces the patient’s complaint or a different pain?), clicking or limitation in range of motion? Not all tests look for the same thing. Third, the clinician must acknowledge the validity of each test. One way to look at it is, that the act of clinical examination must be executed and chosen wisely, whilst the results of the tests can only be interpreted in the context of the history, the aggregate of tests, the additional imaging when advisable and the experience of the clinician. This is the art of clinical work informed by science, but let’s not overstate our findings too “artistically”.