Multiple choice quiz – hip diagnosis
Hip diagnosis can be elusive at times – it can get even more confusing with imaging.
This quiz will test your depth of knowledge of clinical and imaging findings for hip pathologies.
Which clinical feature can be used to differentiate a labral tear from FAI?
Which of these are risk factors for congential hip dysplasia? Select two factors.
Please select 2 correct answers
Which is NOT a risk factor for a pelvic bone stress injury?
The Flexion-Adduction-Internal Rotation (FAddIR) test of the hip is:
Which blood test findings would indicate an increased risk of bone stress injuries? Select 2 answers
Please select 2 correct answers
Meralgia Paraesthetica (aka. "Skinny Jeans syndrome") causes neural symptoms on the anterolateral thigh. It can be confirmed with which muscle test?
Which is NOT a risk factor for a Slipped Capital Femoral Epiphysis (SCFE)?
When diagnosing an unstable SCFE, which clinical finding would be supportive of that diagnosis?
The Adductor Squeeze test is a resisted muscle test for the Adductor group. Which other pathologies may also be symptomatic for groin pain with this test? Select two answers
Please select 2 correct answers
There are a number of features used to identify Osteoarthritis on X-ray. Which feature is NOT present on this scan?
Case courtesy of Dr Ian Bickle, Radiopaedia.org, rID: 79434Share your Results:
You can see how much you know and pick up a few gems of clinical wisdom along the way.
After you’re done, continue the learning with our case studies – there’s cases on anterior hip pain and complex hip pain case to challenge yourself on.
Why hip pain can be so challenging for Physios
Ever wondered what makes hips so different from other lower limb joints?
Physios are quite good at diagnosing ankle injuries, or knee injuries.
But hip diagnosis can seem like there’s an element of a number of different pathologies, so it’s hard to put a name to it.
And that’s actually quite accurate – after only 3 months of symptoms, around 66% of hip/groin symptoms have two (or more) causative pathologies.
It’s assumed that this is because the abnormal loading patterns caused by the pain from the first pathology will then generate secondary pathologies.
Why do you need to know this?
If you get a patient frustrated by chronic hip pain for 6 months, ordering an MRI can confuse the issue even more.
Report: “Mild acetabular osteochondral surface degeneration, labral tear, gluteal tendinopathy, pubic symphysis sclerosis…”
So how do you get to the underlying issue?
This is where you need a solid clinical assessment, some great clinical reasoning and a range of functional tests to join the dots.
Your functional testing is particularly important to rationalise the behaviour of each finding and begin to exclude different hip diagnosis options on your list.
“The MRI may have shown pathology XYZ but the functional test of ABC wasn’t symptomatic, so it’s unlikely to be a source of symptoms.”
You also need to know which tests can confirm or exclude the presence of a specific pathology (hint: it’s one of the questions in the quiz!)
The proof is in the pudding!
It’s an old phrase (I mean, who makes pudding these days…) but it holds true for hip diagnosis – if it responds as expected to treatment, you’ve got a good chance that you’ve got the right diagnosis.
Going through all the hip diagnosis steps above is great, but how do you know if you’ve got it right if an MRI can’t even confirm it conclusively?
You treat it and see what happens.
This isn’t just about getting an improvement with treatment, it’s about getting an expected response to treatment.
If one session of exercise completely resolves your femoral neck bone stress pain, it wasn’t femoral neck bone stress pain!
It’s great that the pain is gone, but that’s not the expected response to exercise for that hip diagnosis.
So you need to figure out what happened.
Is the diagnosis wrong?
Is the patient just having a good day?
Is the patient providing a biased report to please you, or to get back to sport sooner?
Don’t automatically assume you got it wrong – changing your diagnosis can undermine the patient’s confidence in your ability.
Just take another look at a few key tests and work out how you want to proceed.
It’s also helpful to know that you don’t need to come up with an exact hip diagnosis.
Although it sounds awesome to declare that the diagnosis is a Proximal TFL enthesopathy, it also backs you into a corner.
You made a very specific call, what if your hip diagnosis is not accurate?
On the first visit, I always provide an explanation of the condition without putting a specific name to it.
Instead of “Proximal TFL enthesopathy”, it’s referred to as “an overload of the muscle attachment”.
If it doesn’t respond as expected, it’s still an overload issue – it’s just not the exact one I was expecting.
If you get pressed on day 1 to provide an exact diagnosis, you can explain how it’s got features resembling an XYZ hip diagnosis but we’ll confirm based on how it looks after another session or two.
How can you improve at hip diagnosis?
Short answer – never stop learning and keep an open mind (any previous learning can be challenged, nothing is known for sure…)
Read extensively but don’t be too swayed by just one paper.
Learn what each clinical test can actually tell us – not what it was designed for, but what it actually confirms/excludes (many “special” tests don’t actually confirm the target pathology but they can exclude other pathologies).
Work on your clinical reasoning – discuss cases in your clinic, test yourself on case studies, review your cases with someone. It all contributes to refining your reasoning.