Arlington, twist tests may be more sensitive, specific in diagnosing hip labral tears
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Key takeaways:
- The Arlington test had a higher sensitivity compared with the twist test and the flexion-adduction-internal rotation/impingement test.
- The twist test had a higher specificity compared with the Arlington test.
Results showed the Arlington test may be more sensitive and the twist test may be more specific in diagnosing hip labral tears compared with the traditional flexion-adduction-internal rotation/impingement test.
“The twist test and the Arlington test can be added to a clinician’s armamentarium of what they can do in physical exams to find out whether a patient needs an MRI or not,” Derek H. Ochiai, MD, of the National Hip Center at the Nirschl Orthopaedic Center, told Healio.
Ochiai and colleagues retrospectively reviewed the clinical examination findings of 283 patients with hip labral tears. Researchers reviewed the Arlington, twist, and flexion-adduction-internal rotation (FADIR)/impingement tests. They also calculated diagnostic accuracy statistics for each test using magnetic resonance arthrography as the reference standard.
Results showed the Arlington test had a sensitivity of 0.94, a specificity of 0.33, a positive predictive value of 0.95 and a negative predictive value of 0.26.
“The twist test had a sensitivity of 68%, so it was less sensitive than the Arlington test, but it was more specific for labral tears, meaning it had a specificity of 72%,” Ochiai said. “Meaning if someone was twist-test positive, there was a high chance that that patient did have a labral tear. And if the patient had a labral tear, then the Arlington test was 94% sensitive.”
Researchers also noted the twist test had a specificity of 0.72, a positive predictive value of 0.97 and a negative predictive value of 0.13. In comparison, researchers found the FADIR/impingement test had a sensitivity of 0.43, a specificity of 0.56, a positive predictive value of 0.93 and a negative predictive value of 0.06.
“As our physical exam acumen improves ... and you can have a good idea of what you would see on MRI and are prepared to address that during surgery, then maybe the need for MRI would be diminished,” Ochiai said. “That would help with our health care costs and, overall, improve health equity for everyone.”
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