The Stinchfield Test

Original Editor - Matt Huey

Top Contributors - Matt Huey

Introduction

The Stinchfield Test or the Resisted Hip Flexion test, comes from Dr. Frank Stinchfield, MD who was a well renowned practitioner and professor. He was the author of over 100 articles and known for expertise in the hip. This test was utilized as a way to distinguish if a hip pathology causing pain in the groin, thigh, buttock, knee or shin was intra-articular or extra-articular. This test was was said to detect intra-articular pathologies such as arthritis, synovitis, occult femoral neck fracture and/or the failure or loosening of a prosthetic^[1].

Technique

The performance of this test is simple

Patient is in the supine position
Ask the patient to actively raise their leg off the table/surface a few inches
If no pain is produced, apply a gentle downward force on the patient's leg

A positive response is a reproduction of the patient's pain that is in the groin, thigh, buttock or knee. Weakness may or may not be present.

The belief is that the active elevation causes the muscles that cross the hip to contract and the hip joint reactive force (the force of the femora head into the acetabulum) is increased.

There could be pain produced due to neural irritation from the sciatic nerve being tensioning, since it is similar to the straight leg raise test, or pain from an abscess or iliopsoas tendonitis, but these are extra-articular in nature.

Research

There is little for direct research on the Stinchfield Test, but it has been used in clusters for diagnosing hip pathologies. Maslowski et al.^[2] looked at 50 subjects with hip pain and gave a rating of pain using the VAS. A series of 4 provocation tests were performed (FABER/Patrick's Test, Stinchfield, Scour, and IROP (Internal Rotation Over Pressure)). Subjects then underwent an intra-articular injection. Subjects then gave a VAS pain rating and if subjects reported an 80% or more decrease in pain, it was determined the symptoms were intra-articular. Of the tests used, the Stinchfield was the most specific (32%) compared to FABER (25%), Scour (29%) and IROP (18%). The sensitivity of the Stinchfield was 59% (FABER 82%, Scour 50%, IROP 96%).

Troelsen et al.^[3] utilized this test along an impingement test (IROP), FABER, ultrasound, and MR arthrography to diagnose labral tears. The Stinchfield test was only positive in 1 of the 18 subjects. It was found the impingement test was better at determining labral tears but the use of ultrasound followed by MR arthrography was more reliable if the impingement test was negative but symptoms remain.

References

↑ McGrory, B. J. (1999). Stinchfield resisted hip flexion test. Hosp Physician, 35(9), 41
↑ Maslowski, E., Sullivan, W., Harwood, J. F., Gonzalez, P., Kaufman, M., Vidal, A., & Akuthota, V. (2010). The diagnostic validity of hip provocation maneuvers to detect intra-articular hip pathology. Pm&r, 2(3), 174-181.
↑ Troelsen, A., Mechlenburg, I., Gelineck, J., Bolvig, L., Jacobsen, S., & Søballe, K. (2009). What is the role of clinical tests and ultrasound in acetabular labral tear diagnostics?. Acta orthopaedica, 80(3), 314-318.

[1] McGrory, B. J. (1999). Stinchfield resisted hip flexion test. Hosp Physician, 35(9), 41

[2] Maslowski, E., Sullivan, W., Harwood, J. F., Gonzalez, P., Kaufman, M., Vidal, A., & Akuthota, V. (2010). The diagnostic validity of hip provocation maneuvers to detect intra-articular hip pathology. Pm&r, 2(3), 174-181.

[3] Troelsen, A., Mechlenburg, I., Gelineck, J., Bolvig, L., Jacobsen, S., & Søballe, K. (2009). What is the role of clinical tests and ultrasound in acetabular labral tear diagnostics?. Acta orthopaedica, 80(3), 314-318.

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