ePoster #301 - ISHA Annual Scientific Meeting 2016

Accuracy of Three Clinical Tests to Diagnose Hamstring Syndrome in Patients with Posterior Hip Pain

Ricardo Goncalves Schroder, PT, Dallas, TX UNITED STATES
Robroy L. Martin, PhD, PT, CSCS, Pittsburgh, PA UNITED STATES
Juan Gomez Hoyos, MD, Medellin, ANTIOQUIA COLOMBIA
Anthony Khoury, MSc, Dallas, TX UNITED STATES
Ian James Palmer, PhD, Oklahoma City, OK UNITED STATES
Hal David Martin, DO, Dallas, TX UNITED STATES

Hip Preservation Center Hip Preservation Center at Baylor Scott&Withe Health System, Dallas, Texas, UNITED STATES

FDA Status Not Applicable

Summary: Hamstrings syndrome is characterized by a proximal hamstring tendon injury often associated with scarring fibrosis around the sciatic nerve mimicking deep gluteal syndrome. The purpose of this study was to define the diagnostic accuracy of the active hamstring at 30 and 90 knee flexion and the long stride heel strike test as a valuable tool for the differential diagnosis of posterior hip pain

Abstract:
Introduction
Hamstrings syndrome is characterized by a proximal hamstring tendon injury often associated with scarring fibrosis around the sciatic nerve mimicking deep gluteal syndrome. The purpose of this study was to define the diagnostic accuracy of 3 tests for identifying individuals with hamstring syndrome.

Methods
42 subjects (female = 32, male = 10) with a mean age of 50.3years (range, 15-77; SD, 14.5 years) underwent Magnet Resonance Imaging (MRI) evaluation for posterior hip region because hip pain. Prior to the MRI, a routine clinical examination was performed on each subject that included the active hamstring tests at 30° and 90° knee flexion and the long stride heel strike test during gait. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were calculated for each test.

Results
On MRI findings, 64% (27/42) of subjects were diagnosed with hamstring pathology. The mean duration of symptoms was 31.4 weeks (range of 3 – 120, SD ± 34.9). Of these 27 subjects, 21 (78%) presented complete (25.9%) or partial (51.8%) hamstring insertion tear. Six subjects (22%) presented proximal tendinopathy. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio for each test were as follows: active 30° knee flexion: 0.73, 0.97, 23.43, 0.28, and 84.73; active 90° knee flexion: 0.70, 0.97, 22.40, 0.31, and 72.33; the long stride heel strike test: 0.55, 0.97, 17.71, 0.17, and 161.89. The most accurate findings were obtained when the results of the three tests were combined, with sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of 0.95, 0.97, 0.06, 0.11, and 547.67, respectively.

Conclusion
The active hamstring tests at 30° and 90° knee flexion and long stride heel strike test have good diagnostic accuracy, particularly with specificity, when performed in isolation. The diagnostic accuracy was improved when the results of the 3 tests were combined. The use of active hamstring at 30 and 90 knee flexion and the long stride heel strike test are a valuable tool for the differential diagnosis of posterior hip pain.