In-office tests may detect hip tendon problems before MRI

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Two simple tests that can be done in a doctor's office may be able to rule in or out a painful hip condition that is usually hard to diagnose without magnetic resonance imaging (MRI), according to a small study.

A common overuse injury, gluteal tendinopathy can be treated with rest and stretching. But hip pain can be hard to diagnose, and that may lead to inappropriate treatment or unnecessary surgery if gluteal tendinopathy is misdiagnosed as a lumbar spine issue or hip joint osteoarthritis, the authors write.

"It is important to identify the condition because this will help better target therapy and we believe this study has moved the field forward considerably in terms of our understanding of clinical tests that help us diagnose the condition," said senior author Bill Vicenzino of the University of Queensland in Brisbane, Australia.

"We found more tests that when negative would rule out the likelihood of the condition being present and only one that strongly ruled in the condition if it was positive," Vicenzino said.

The researchers studied 65 people, ages 35 to 70 years, with pain on the side of their hip. First clinicians palpated (felt with their hands) the painful hip and had participants perform a series of movements applying weight or pressure to the joint and tendons. Then participants had MRI scans of the painful hip, which were analyzed by a radiologist.

About half of the participants were diagnosed with gluteal tendinopathy based on clinical examination and tests, while more than three-quarters had gluteal tendinopathy based on MRIs, according to the results published in the British Journal of Sports Medicine.

Hip palpation had the lowest false-positive rate of the clinical tests, and was the best test for ruling out the presence of gluteal tendinopathy.

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When a patient had pain in the hip within 30 seconds of standing on that leg, there was a 98 percent change that they would have gluteal tendinopathy on the MRI.

Of the 65 participants, 30 were incorrectly diagnosed as not having gluteal tendinopathy with in-office exams, while an MRI showed that they did have the condition.

Standing on one leg and hip palpation are two very simple tests that can be quickly done and seem to provide the best information, Vicenzino said. "The clinical tests should suffice in a physician's or physical therapy practice without recourse to expensive and time consuming investigations like MRI, but if MRI is to be used, it should be interpreted alongside a good clinical examination and the results of the studied tests."

Doctors should take a detailed history of activity levels and changes in those levels and common postural habits as well, he said.

"This condition tends to be prevalent in middle aged females who often are challenged with finding time to exercise in order to maintain some physical and psychological health alongside having family and work commitments," he told Reuters Health by email.

It is key to avoid going from no physical activities for several days or weeks and then fitting in several sessions on a free weekend because this boom-bust cycle tends to worsen this tendinopathy, Vicenzino noted.

"So the identification of gluteal tendinopathy will guide which movements and postures to adopt or avoid (e.g., sitting cross legged, or hitching on one hip) along with which are the best activities to undertake (e.g., avoiding crossing midline with feet while walking and walking flat before commencing hills and slopes)," he said.