From the Guidelines
Hip flexor tendinitis can be diagnosed through several clinical tests, with the Thomas test, resisted hip flexion test, and psoas stretch test being the most useful assessments. These tests are important because they help differentiate hip flexor tendinitis from other conditions like hip osteoarthritis or labral tears. The Thomas test is performed by having the patient lie supine with one leg held to the chest while the other leg remains extended, and if the extended leg rises off the examination table, this indicates hip flexor tightness or tendinitis 1. The resisted hip flexion test involves the patient attempting to lift their thigh against resistance applied by the examiner, and pain with this maneuver suggests hip flexor tendinitis. The psoas stretch test can also help diagnose this condition by having the patient lie at the edge of the table with one leg hanging down while the other leg is pulled toward the chest, and pain in the anterior hip during these tests typically indicates hip flexor tendinitis.
Diagnostic Criteria
The diagnostic criteria for hip flexor tendinitis include a combination of clinical signs and diagnostic imaging, with anteroposterior (AP) pelvis and lateral femoral head–neck radiographs being recommended as the initial diagnostic imaging 1. Advanced imaging such as MRI or CT scan may be used for more clarity on the underlying morphology of the hip. The FADIR test has been examined in several studies and is recommended as a clinical measure to potentially screen for all hip-related pain, despite its noted limitations 1.
Treatment
Early diagnosis allows for appropriate treatment, which typically includes:
- Rest
- Ice
- Anti-inflammatory medications like ibuprofen (400-600mg three times daily with food for 1-2 weeks)
- Gentle stretching exercises once acute pain subsides
- Physical therapy focusing on proper stretching techniques and strengthening of surrounding muscles is often necessary for complete recovery and prevention of recurrence.
It is essential to note that imaging should never be used in isolation but combined with the patient’s symptoms and clinical signs when making treatment and other relevant decisions 1.
From the Research
Hip Flexor Tendinitis Test
- The diagnosis of hip flexor tendinitis is typically based on a combination of clinical evaluation and imaging studies 2.
- Anterior hip pain, which includes hip flexor injuries, can be diagnosed through a physical examination and imaging tests such as radiography, ultrasonography, or magnetic resonance imaging 2.
- There is no specific test mentioned in the provided studies for diagnosing hip flexor tendinitis.
- However, the studies discuss the treatment and management of tendinopathy, including the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and celecoxib 3, 4, 5.
- The effects of NSAIDs on tendinopathic tissue and tendon repair have been investigated, with some studies suggesting that ibuprofen may have a beneficial effect on limiting adhesion formation after tendon repair 5.