Can hip abduction and external rotation discriminate sacroiliac joint pain?

Comparative Analysis of the Pain Provocation Test and the HABER Test to Diagnose Nonspecific Low-Back Pain Associated with the Sacroiliac Joint

Background

This study aimed to investigate the correlation between the pain provocation test and the hip abduction-external rotation (HABER) test for diagnosing low-back pain (LBP)-related sacroiliac joint (SIJ) syndrome, and to determine the efficacy of the HABER test as a potential diagnostic tool for SIJ syndrome.

Material/Methods

One hundred patients with LBP participated. The first and second examiner examined the patients using the pain provocation test and the HABER test, respectively. Positive and negative findings were analyzed to determine the correlation and reliability.

Results

The HABER test showed similar pain reproduction in groups that were positive or negative for SIJ syndrome (P<0.05). Based on the analysis of the receiver-operating characteristic curve, the cutoff values from the HABER test were found to be 29° and 32° of external rotation in the left and right hip joints, respectively.

Conclusions

The HABER test can reproduce similar level of pain in patients with chronic LBP associated with SIJ syndrome, and it can be used as a diagnostic tool in patients presenting with chronic LBP.

Knee Flexion Angle Following Total Knee Arthroplasty Relates to a Preoperative Range of Motion of the Hip

BACKGROUND

Many factors have been reported to affect postoperative range of knee flexion after total knee arthroplasty (TKA); however, no study has reported the impact of preoperative range of motion of the hip to the postoperative flexion angle of the knee thus far.

METHODS

Of 38 consecutive patients who underwent posterior-stabilized TKA, we assessed 21 patients after excluding 17 patients who met exclusion criteria. The range of motion of the knee and the hip, age, body-mass index, serum albumin level, HbA1c, Kellgren-Lawrence grade, knee extension strength and radiological femorotibial angle as well as postoperative knee flexion angle at three months were evaluated. The preoperative data and the knee flexion angle at three months after TKA were compared using Spearman's rank correlation coefficient.

RESULTS

Knee flexion angle at three months after TKA was positively correlated with preoperative flexion (ρ = 0.616, p = 0.007) and external rotation angle (ρ = 0.576, p = 0.012) of the hip as well as preoperative knee flexion angle (ρ = 0.797, p = 0.001). There were no correlations between postoperative knee flexion angle and other preoperative data.

CONCLUSIONS

Patients with restricted flexion and/or external rotation of the hip may have contractures of Gluteus maximus, Gluteus medius and Tensor fasciae latae, which can cause hypertension of iliotibial tract. It may cause decreased internal rotation of the tibia when the knee is flexed, which affects postoperative knee flexion angle, thus limited flexion and/or external rotation of the hip might restrict knee flexion angle following TKA.

Innominate segment deformation during passive hip abduction and external rotation

BACKGROUND

Electromagnetic palpation-digitization technique for measurement of innominate motion involves calculation of innominate rotation using the innominate vector length in the neutral (NEUT) and combined hip abduction and external rotation (HABER) test positions. The innominate vector length [i.e., the segment between anterior superior iliac spine (ASIS) and posterior superior iliac spine (PSIS)] is not a rigid structure and its deformation could introduce an error influencing the final innominate rotation measurement.

OBJECTIVES

The aim of this study is to determine if there is significant deformation occurring in innominate vector length when the hip is loaded into the HABER test position.

METHOD

A cross sectional study using sixteen healthy individuals and a single tester was conducted. Four pelvic landmarks, left and right PSIS and ASIS, were palpated and digitized using 3D digitizing stylus of Polhemus electromagnetic tracking device, in two hip test positions, NEUT and 50° HABER. The innominate vector lengths were calculated from the 3D coordinates of pelvic landmarks, for each hip test positions.

RESULTS AND CONCLUSION

Paired t-tests demonstrated no significant differences (p > 0.05) in the innominate vector lengths at the side of the load as well as the opposite innominate when either the right or left hip was loaded; thus indicating no significant bone deformation in innominate segment during the HABER test position.

Diagnosis and Characters of Non-Specific Low Back Pain in Japan: The Yamaguchi Low Back Pain Study

Study Design

Cross sectional data from the Yamaguchi low back pain study conducted in Yamaguchi prefecture, Japan, was used for this analysis.

Methods

A total of 320 patients were recruited from walk-in orthopedic clinics in Yamaguchi Prefecture, Japan. Patients visited the clinics primarily for low back pain (LBP) and sought treatment between April and May 2015. A self-questionnaire was completed by patients, while radiographic testing and neurological and physical examination was performed by the orthopedist in each hospital. The cause and characters of LBP was determined following examination of the data, regional anesthesia and block injection.

Results

‘Specific LBP’ was diagnosed in 250 (78%) patients and non-diagnosable, ‘non-specific LBP’ in 70 (22%) patients. The VAS scores of patients were: LBP, 5.8±0.18; leg pain, 2.9±0.18 and the intensity of leg numbness was 1.9±0.16. Item scores for SF-8 were: general health, 46.6±0.40; physical function, 43.5±0.51; physical limitations, 42.8±0.53; body pain, 42.1±0.52; vitality, 48.4±0.37; social function, 46.9±0.53; emotional problems, 48.9±0.43; mental health, 46.9±0.43.

Conclusions

The incidence of non-specific LBP in Japan was lower than previous reports from western countries, presumably because of variation in the diagnosis of LBP between different health care systems. In Japan, 78% of cases were classified as ‘specific LBP’ by orthopedists. Identification of the definitive cause of LBP should help to improve the quality of LBP treatment.