Intracapsular pressures in the flexion-abduction-external rotation and flexion-adduction-internal rotation tests and their comparison with classic hip range of motion: A cadaveric assessment

  • Marc-Olivier St-Pierre
    Correspondence
    Corresponding author at: Chaire de recherche en anatomie fonctionnelle, Université du Québec à Trois-Rivières, 3351, boul. des Forges C.P. 500, Trois-Rivières, QC G8Z 4M3, Canada.
    Affiliations
    Chaire de recherche en anatomie fonctionnelle, Université du Québec à Trois-Rivières, 3351, boul. des Forges C.P. 500, Trois-Rivières, QC G8Z 4M3, Canada

    Département d'anatomie, Université du Québec à Trois-Rivières, 3351, boul. des Forges C.P. 500, Trois-Rivières, QC G8Z 4M3, Canada
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  • Félix-Antoine Lavoie
    Affiliations
    Chaire de recherche en anatomie fonctionnelle, Université du Québec à Trois-Rivières, 3351, boul. des Forges C.P. 500, Trois-Rivières, QC G8Z 4M3, Canada

    Département des Sciences de l'activité physique, Université du Québec à Trois-Rivières, 3351, boul. des Forges C.P. 500, Trois-Rivières, QC G8Z 4M3, Canada
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  • Jean-Michel Brismée
    Affiliations
    Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Science Center, 3601 4th Street, Lubbock, TX 79430, USA
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  • Marion Hoffmann
    Affiliations
    Université Claude Bernard Lyon 1, Université Gustave Eiffel, Laboratoire de Biomécanique et Mécanique des Chocs UMR_T9406, 25 avenue François Mitterrand, Bron F69622, France
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  • Mickaël Begon
    Affiliations
    École de Kinésiologie et des Sciences de l'Activité Physique, Faculté de Médecine, Université de Montréal, Campus Laval, 1700 rue Jacques Tétreault, Laval, QC H7N 0B6, Canada

    CHU Sainte-Justine Research Center, Canada
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  • Antony Bertrand-Grenier
    Affiliations
    Département de chimie, biochimie et physique, Université du Québec à Trois-Rivières, 3351, boul. des Forges C.P. 500, Trois-Rivières, QC G8Z 4M3, Canada

    CIUSSS de la Mauricie-et-du-Centre-du-Québec, Centre hospitalier affilié universitaire régional, 1991 Boulevard du Carmel, Trois-Rivières, QC G8Z 3R9, Canada
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  • Stéphane Sobczak
    Affiliations
    Chaire de recherche en anatomie fonctionnelle, Université du Québec à Trois-Rivières, 3351, boul. des Forges C.P. 500, Trois-Rivières, QC G8Z 4M3, Canada

    Département d'anatomie, Université du Québec à Trois-Rivières, 3351, boul. des Forges C.P. 500, Trois-Rivières, QC G8Z 4M3, Canada
    Search for articles by this author

      Highlights

      • Flexion-abduction-external rotation shows a depressurization in the lateral portion.
      • Flexion-adduction-internal-rotation shows high pressure in the lateral compartment.
      • The pressure depends on the tests being performed and the compartment assessed.

      Abstract

      Background
      Flexion-Abduction-External-Rotation and Flexion-Adduction-Internal-Rotation tests are used to reproduce pain at the hip during clinical assessment. As pain can be elicited by high intracapsular pressure, no information has been provided regarding intracapsular pressure during these pain provocative tests.
      Methods
      Eight hip joints from four cadaveric specimens (78.5 ± 7.9 years) were assessed using intra-osseous tunnels reaching the lateral and acetabular compartments. To simulate synovial liquid, 2.7 ml of liquid were inserted in both compartments using adaptor injectors. Optic pressure transducers were used to measure pressure variations. Pressures were compared between compartments in each test and between tests for each compartment. Both tests were compared with uniplanar movements.
      Findings
      The Flexion-Adduction-Internal-Rotation test showed a significant difference between pressure measured in the lateral (27.17 ± 42.63 mmHg) and acetabular compartment (−26.80 ± 29.26 mmHg) (P < 0.006). The pressure measured in the lateral compartment during the Flexion-Adduction-Internal-Rotation test (27.17 ± 42.63 mmHg) was significantly higher than in the Flexion-Abduction-External-Rotation test (−8.09 ± 15.09 mmHg) (P < 0.010). The pressure measured in the lateral compartment in the Flexion-Abduction-External-Rotation test was significantly lower than during internal rotation (P = 0.011) and extension (P = 0.006).
      Interpretation
      High intracapsular pressure is correlated with greater pain at the hip. Clinicians should assess pain with caution during the Flexion-Adduction-Internal-Rotation test as this test showed high intracapsular pressures in the lateral compartment. The Flexion-Abduction-External-Rotation is not influenced by high intra-capsular pressures.

      Keywords

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