Simple tests may head off unneeded MRIs for hip pain

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Patients who have marked lateral hip pain within 30 seconds of performing a single-leg stand on the affected side are highly likely to have gluteal tendinopathy (GT), a painful but largely self-treatable overuse condition, according to a small study published online in the British Journal of Sports Medicine.

The study also showed that patients with the same or similar pain who are not tender to the physician’s touch are unlikely to have GT that would be detected on MRI.

This simple equation is good information for orthopedic specialists to have at hand, given the high cost of unnecessary MRI.

Alison Grimaldi, PhD, of the University of Queensland in Australia and colleagues further note that patients with GT are often misdiagnosed, resulting in inappropriate surgery on top of the imaging.

The research team looked at the cases of 65 participants with lateral hip pain.

They recorded the results following physician palpation of the femur and several pain-provocation tests, then had a radiologist blinded to the in-office findings interpret MRI scans.

“Pain reported within 30 seconds of standing on the affected limb conclusively moves a (nominal) 50 percent pretest probability of GT presence on MRI to a post-test probability of 98 percent (specificity 100 percent),” the authors report.

Meanwhile, “no pain on palpation (80 percent sensitivity) would rule out” GT’s presence, Grimaldi and co-authors write.

The in-office testing is impressive but not foolproof, as 20 participants (31 percent) had GT on MRI that the docs missed on the pain-tolerance tests.