臀下垂体检可用于指导先进的影像学和手术决策

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2025-08-01 DOI:10.1016/j.asmr.2025.101176

Dylan Quintana B.S. , Nathan Barber B.S. , Hillary Rawson M.S. , Zachary Wade M.D. , Devin Eddington M.S. , Angela P. Presson Ph.D. , Travis G. Maak M.D.

{"title":"臀下垂体检可用于指导先进的影像学和手术决策","authors":"Dylan Quintana B.S. , Nathan Barber B.S. , Hillary Rawson M.S. , Zachary Wade M.D. , Devin Eddington M.S. , Angela P. Presson Ph.D. , Travis G. Maak M.D.","doi":"10.1016/j.asmr.2025.101176","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><div>To establish the clinical utility of the hip drop test (HDT) for diagnosing hip abductor tendon tears as well as for predicting future surgery and to identify patient risk factors associated with tears and surgery.</div></div><div><h3>Methods</h3><div>A single institution’s electronic medical records, comprising patients treated by a single sports medicine fellowship-trained orthopaedic surgeon, were reviewed to identify patients aged 18 years or older with suspected hip abductor tendon tears with documented HDT results who underwent hip magnetic resonance imaging (MRI). Hip MRI served as the diagnostic gold standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated, and logistic regression analysis of various associated factors was performed.</div></div><div><h3>Results</h3><div>Our initial review yielded 366 patients. After we excluded patients without positive or negative HDT results, as well as those without MRI results, 261 patients underwent analysis. Of these patients, 245 had negative HDT results whereas 16 had positive results. Of the patients with positive HDT results, 8 underwent surgery. Sensitivity for a future MRI-confirmed diagnosis of hip abductor tendon tear was 30.4% (95% confidence interval [CI], 19.1%-44.8%), and specificity was 99.1% (95% CI, 96.7%-99.7%). The PPV of the HDT for a future MRI-confirmed diagnosis was 87.5% (95% CI, 64.0%-96.5%), and the NPV was 86.9% (95% CI, 82.1%-90.6%). For the prediction of future hip abductor tendon surgery, a positive HDT result yielded a sensitivity of 80.0% (95% CI, 49.0%-94.3%), specificity of 96.8% (95% CI, 93.8%-98.4%), PPV of 50.0% (95% CI, 28.0%-72.0%), and NPV of 99.2% (95% CI, 97.1%-99.8%).</div></div><div><h3>Conclusions</h3><div>The HDT is a reliable clinical examination maneuver for diagnosing hip abductor tendon tears in patients with lateral hip pain when performed by an experienced medical provider. The HDT shows a high NPV for both a hip abductor tendon tear diagnosis on MRI and the prediction of future surgery and may be used to guide initial clinical decision making. Patients with lateral hip pain and negative HDT results may forego immediate advanced imaging and, instead, consider nonoperative management. Additionally, demographic variables such as female sex, older age, and higher body mass index raise the risk of a hip abductor tendon tear and thus increase suspicion for an abductor tendon tear requiring advanced imaging and, possibly, future surgery.</div></div><div><h3>Level of Evidence</h3><div>Level III, development of diagnostic criteria based on nonconsecutive patients.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 4","pages":"Article 101176"},"PeriodicalIF":0.0000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Hip Drop Physical Examination Test Can Be Used to Guide Advanced Imaging and Surgical Decision Making\",\"authors\":\"Dylan Quintana B.S. , Nathan Barber B.S. , Hillary Rawson M.S. , Zachary Wade M.D. , Devin Eddington M.S. , Angela P. Presson Ph.D. , Travis G. Maak M.D.\",\"doi\":\"10.1016/j.asmr.2025.101176\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><div>To establish the clinical utility of the hip drop test (HDT) for diagnosing hip abductor tendon tears as well as for predicting future surgery and to identify patient risk factors associated with tears and surgery.</div></div><div><h3>Methods</h3><div>A single institution’s electronic medical records, comprising patients treated by a single sports medicine fellowship-trained orthopaedic surgeon, were reviewed to identify patients aged 18 years or older with suspected hip abductor tendon tears with documented HDT results who underwent hip magnetic resonance imaging (MRI). Hip MRI served as the diagnostic gold standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated, and logistic regression analysis of various associated factors was performed.</div></div><div><h3>Results</h3><div>Our initial review yielded 366 patients. After we excluded patients without positive or negative HDT results, as well as those without MRI results, 261 patients underwent analysis. Of these patients, 245 had negative HDT results whereas 16 had positive results. Of the patients with positive HDT results, 8 underwent surgery. Sensitivity for a future MRI-confirmed diagnosis of hip abductor tendon tear was 30.4% (95% confidence interval [CI], 19.1%-44.8%), and specificity was 99.1% (95% CI, 96.7%-99.7%). The PPV of the HDT for a future MRI-confirmed diagnosis was 87.5% (95% CI, 64.0%-96.5%), and the NPV was 86.9% (95% CI, 82.1%-90.6%). For the prediction of future hip abductor tendon surgery, a positive HDT result yielded a sensitivity of 80.0% (95% CI, 49.0%-94.3%), specificity of 96.8% (95% CI, 93.8%-98.4%), PPV of 50.0% (95% CI, 28.0%-72.0%), and NPV of 99.2% (95% CI, 97.1%-99.8%).</div></div><div><h3>Conclusions</h3><div>The HDT is a reliable clinical examination maneuver for diagnosing hip abductor tendon tears in patients with lateral hip pain when performed by an experienced medical provider. The HDT shows a high NPV for both a hip abductor tendon tear diagnosis on MRI and the prediction of future surgery and may be used to guide initial clinical decision making. Patients with lateral hip pain and negative HDT results may forego immediate advanced imaging and, instead, consider nonoperative management. Additionally, demographic variables such as female sex, older age, and higher body mass index raise the risk of a hip abductor tendon tear and thus increase suspicion for an abductor tendon tear requiring advanced imaging and, possibly, future surgery.</div></div><div><h3>Level of Evidence</h3><div>Level III, development of diagnostic criteria based on nonconsecutive patients.</div></div>\",\"PeriodicalId\":34631,\"journal\":{\"name\":\"Arthroscopy Sports Medicine and Rehabilitation\",\"volume\":\"7 4\",\"pages\":\"Article 101176\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Arthroscopy Sports Medicine and Rehabilitation\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2666061X25001026\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arthroscopy Sports Medicine and Rehabilitation","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666061X25001026","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

摘要

目的探讨髋下垂试验（HDT）在诊断髋关节外展肌腱撕裂、预测未来手术以及识别与撕裂和手术相关的患者危险因素方面的临床应用价值。方法回顾某一机构的电子医疗记录，包括由一名运动医学研究员培训的骨科医生治疗的患者，以确定年龄在18岁或以上的患者，他们怀疑髋关节外展肌腱撕裂，并记录了HDT结果，并接受了髋关节磁共振成像（MRI）。髋关节MRI是诊断的金标准。计算敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV），并对各相关因素进行logistic回归分析。我们的初步审查纳入了366例患者。在排除了HDT阳性或阴性以及MRI阴性的患者后，我们对261例患者进行了分析。在这些患者中，245例HDT结果为阴性，16例为阳性。在HDT阳性的患者中，有8人接受了手术。未来mri确诊髋关节外展肌腱撕裂的敏感性为30.4%(95%可信区间[CI]， 19.1%-44.8%)，特异性为99.1% （95% CI, 96.7%-99.7%）。HDT对未来mri确诊的PPV为87.5% (95% CI, 64.0%-96.5%)， NPV为86.9% （95% CI, 82.1%-90.6%）。对于未来髋关节外展肌腱手术的预测，HDT阳性结果的敏感性为80.0% (95% CI, 49.0%-94.3%)，特异性为96.8% (95% CI, 93.8%-98.4%)， PPV为50.0% (95% CI, 28.0%-72.0%)， NPV为99.2% （95% CI, 97.1%-99.8%）。结论由经验丰富的医生进行HDT是诊断髋关节外侧疼痛患者髋关节外展肌腱撕裂的可靠临床检查方法。HDT对髋关节外展肌腱撕裂的MRI诊断和对未来手术的预测均显示较高的NPV，可用于指导初步临床决策。髋关节外侧疼痛和HDT阴性的患者可以放弃立即进行高级影像学检查，转而考虑非手术治疗。此外，人口统计学变量，如女性、年龄较大和较高的身体质量指数增加了髋外展肌腱撕裂的风险，因此增加了对外展肌腱撕裂的怀疑，需要先进的成像，并可能需要未来的手术。证据水平III级，基于非连续患者的诊断标准的发展。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

The Hip Drop Physical Examination Test Can Be Used to Guide Advanced Imaging and Surgical Decision Making

Purpose

To establish the clinical utility of the hip drop test (HDT) for diagnosing hip abductor tendon tears as well as for predicting future surgery and to identify patient risk factors associated with tears and surgery.

Methods

A single institution’s electronic medical records, comprising patients treated by a single sports medicine fellowship-trained orthopaedic surgeon, were reviewed to identify patients aged 18 years or older with suspected hip abductor tendon tears with documented HDT results who underwent hip magnetic resonance imaging (MRI). Hip MRI served as the diagnostic gold standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated, and logistic regression analysis of various associated factors was performed.

Results

Our initial review yielded 366 patients. After we excluded patients without positive or negative HDT results, as well as those without MRI results, 261 patients underwent analysis. Of these patients, 245 had negative HDT results whereas 16 had positive results. Of the patients with positive HDT results, 8 underwent surgery. Sensitivity for a future MRI-confirmed diagnosis of hip abductor tendon tear was 30.4% (95% confidence interval [CI], 19.1%-44.8%), and specificity was 99.1% (95% CI, 96.7%-99.7%). The PPV of the HDT for a future MRI-confirmed diagnosis was 87.5% (95% CI, 64.0%-96.5%), and the NPV was 86.9% (95% CI, 82.1%-90.6%). For the prediction of future hip abductor tendon surgery, a positive HDT result yielded a sensitivity of 80.0% (95% CI, 49.0%-94.3%), specificity of 96.8% (95% CI, 93.8%-98.4%), PPV of 50.0% (95% CI, 28.0%-72.0%), and NPV of 99.2% (95% CI, 97.1%-99.8%).

Conclusions

The HDT is a reliable clinical examination maneuver for diagnosing hip abductor tendon tears in patients with lateral hip pain when performed by an experienced medical provider. The HDT shows a high NPV for both a hip abductor tendon tear diagnosis on MRI and the prediction of future surgery and may be used to guide initial clinical decision making. Patients with lateral hip pain and negative HDT results may forego immediate advanced imaging and, instead, consider nonoperative management. Additionally, demographic variables such as female sex, older age, and higher body mass index raise the risk of a hip abductor tendon tear and thus increase suspicion for an abductor tendon tear requiring advanced imaging and, possibly, future surgery.