Hip Assessment

Hip Prone Instability Test | Hip Microinstability Assessment

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Hip Prone Instability Test

Hip Prone Instability Test | Hip Microinstability Assessment

Hip microinstability is a relatively new clinical entity of hip pathology in young patients.

Normal hip stability, as with other joints such as the shoulder, depends on the relationship between bony structures, muscles, and ligaments. In the hip joint that would be the acetabulum, its’ labrum, the ligamentum teres, the capsuloligamentous complex, and various muscles around the joint.

While a direct cause for hip microinstability may not always be identifiable, both traumatic and atraumatic onsets are described in the literature. The pathophysiological mechanism is assumed to be related to repetitive axial and or rotational loading of the hip in the presence of anatomic abnormalities of the previously listed structures.

Common assessments next to a thorough patient history include Hyperlaxity assessment using the Beighton Score, and lately special tests for the condition have been described and evaluated on their validity:

According to Hoppe et al. (2017), The prone instability test has a sensitivity of 33,9% and a specificity of 97,9%. This is the first study to evaluate this test on its validity and has a couple of limitations so the results should be used with caution until further validation has taken place which is why we give it a moderate clinical value.

To conduct the test the patient lies prone and you’re going to stand on the unaffected side. Flex the knee of the affected leg to 90° to use it as a lever to induce external rotation. Place your other hand on the posterior aspect of the greater trochanter. Then while you externally rotate the leg, apply a downward force at the greater trochanter. The reproduction of anterior hip pain is consistent with a positive test result for instability.

Other  orthopedic tests that assess microinstability of the hip are:

 

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References

Hoppe, D. J., Truntzer, J. N., Shapiro, L. M., Abrams, G. D., & Safran, M. R. (2017). Diagnostic accuracy of 3 physical examination tests in the assessment of hip microinstability. Orthopaedic Journal of Sports Medicine, 5(11), 2325967117740121.

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