Accuracy of 3 Clinical Tests to Diagnose Proximal Hamstrings Tears With and Without Sciatic Nerve Involvement in Patients With Posterior Hip Pain.

PURPOSE: To determine the diagnostic accuracy of the active hamstring test at 30° (A-30) and 90° (A-90) of knee flexion, the long stride heel strike (LSHS) test, and combination of the 3 tests for individuals with hamstring tendon tears, with and without sciatic nerve involvement. METHODS: A retrospective review of 564 consecutive clinical records identified 42 subjects with a mean age of 50.31 ± 15 years who underwent a standard physical examination prior to magnetic resonance imaging (MRI) evaluation and diagnostic injection for posterior hip. The physical examination included the A-30, A-90, and LSHS tests. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were calculated to determine the diagnostic accuracy of these 3 tests. RESULTS: Forty-two subjects (female = 32 and male = 10) with a mean age of 50.31 years (range 15-77, ± SD 14.52) met the inclusion criteria and were included in the review. Based on MRI and/or injection, 64.28% (27/42) of subjects were diagnosed with hamstring tear. Fourteen (51.85%) presented with sciatic nerve involvement. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio for each test were as follows: A-30 knee flexion: 0.73, 0.97, 23.43, 0.28, and 84.73; A-90 knee flexion: 0.62, 0.97, 20.00, 0.39, and 51.67; LSHS: 0.55, 0.73, 2.08, 0.61, and 3.44. The most accurate findings were obtained when the results of the A-30 and A-90 were combined, with sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of 0.84, 0.97, 26.86, 0.17, and 161.89, respectively. CONCLUSION: The combination of the active hamstring A-30 and A-90 tests proved to be a highly accurate and valuable tool to diagnose proximal hamstring tendons tears with or without sciatic nerve involvement in subjects presenting with posterior hip pain. LEVEL OF EVIDENCE: Level III, diagnostic study.

A MRI study of the lesser trochanteric version and its relationship to proximal femoral osseous anatomy.

The purpose of this study is to quantify the lesser trochanteric version and determine the angle and the relationship between lesser trochanter and femoral neck version. Investigate the influence of the lesser trochanter version in the width of ischiofemoral space. Two hundred and fifty asymptomatic hips were evaluated with axial magnetic resonance image. The lesser trochanter version was calculated. The difference between the femoral neck version and the lesser trochanter version formed the angle between each structure. The width of ischiofemoral space was measured and its relationship with the lesser trochanter version was determined. The mean lesser trochanter version was -24° ± 11.5° (range, - 54° to + 17°) with a coefficient variation of 47.45%. The mean femoral neck version measured 14.0° ± 10.8° (range, -16° to 50°), with a coefficient variation of 81.32%. The lesser trochanter/femora neck angle was 38.4° ± 9.6° (range, 8° to 67°), coefficient variation of 30%, with a moderate correlation between the structures (r = 0.63, P < 0.01). The mean ischiofemoral space was 22.9.0 ± 7.0 mm (range, 10.3 to 55 mm), and a weak correlation was found between ischiofemoral space and lesser trochanteric version (r = -0.16, P < 0.05). The lesser trochanteric version showed a high variation with a moderate relationship with the femoral neck version. The lesser trochanteric version does not influence the width of the ischiofemoral space.