Stinchfield Test

Stinchfield test (or resisted hip flexion test) is designed to help distinguish between intra-articular and extra-articular hip pathologies causing groin, thigh, buttock, and even pretibial leg pain. It was described by Frank Stinchfield, MD.

The Stinchfield’s test is designed to simulate the normal walking forces across the hip joint and usually elicits pain in the presence of any significant hip pathology such as arthritis, fracture, or infection.

How do you perform the Stinchfield test?

• The patient is positioned in supine position and asked to lift his leg, without bending the knee, to about 30-45 degrees.
• If this maneuver does not reproduce any pain, the clinician applies pressure downward on the patient’s raised leg, in an attempt to extend the flexed hip, while the patient resists the force.
• Pain produced either with or without resistance is assessed for location.

What does a positive Stinchfield test mean?

A positive Stinchfield test demonstrates increasing intra-articular pressure that causes pain in the distribution of the hip’s sensory innervation. Pain in the low back and sacroiliac joint area is not a positive response because hip joint discomfort does not radiate to these areas.

• If the pain is felt in the groin or anterior thigh, it is considered to arise from the hip;
• While if the pain is felt in the buttock or lumbar spine, the sacroiliac joint or lumbar spine is the likely source.

Stinchfield Test Accuracy

Unfortunately, the Stinchfield’s test has not been subjected to criteria validity research, so no sensitivity or specificity numbers are available for this test.

Notes

• Stinchfield test should not be confused with the straight leg raise test used to detect neuro meningeal problems.
• The test is not dependent on the range obtained but rather on the location of symptoms. The only manner in which the two diagnoses could be confused is if a lumbar lesion was producing a restriction of the SLR at or below 30 degrees, but other signs and symptoms would help differentiate between the two.
• This test is performed with the knee extended and the hip only slightly flexed, and active hip flexion is required.
• Extra articular causes of hip pain, such as iliopsoas tendinitis or abscess, can elicit a positive response during the Stinchfield test. Further, patients with radiographic evidence of hip pathology may have no pain with this test. Both of these scenarios are rare and do not detract from the usefulness and simplicity of this test in distinguishing between intra articular and extra articular hip pathology.
• The examiner must keep in mind that pathology involving the hip flexors, such as an avulsion fracture or tendinitis, is also painful with this maneuver.
• The Stinchfield test may be fallacious (false negative) in impacted fragments, capsular contracture, and leverage of distal fragment on acetabular margin. It may be absent (false positive) in a frail patient and cannot be done in hemiplegia or paraplegic patient.
• This maneuver generates a force 1.8 to 2 times the patient’s body weight across the hip joint.

References

1. Dick HM: A tribute to Frank Stinchfield, MD. Clin Orthop September 1994:2–4
2. McGrory, Brian J. et al. “Stinchfield Resisted Hip Flexion Test.” (1999). Link
3. Maslowski E, Sullivan W, Forster Harwood J, Gonzalez P, Kaufman M, Vidal A, Akuthota V. The diagnostic validity of hip provocation maneuvers to detect intra-articular hip pathology. PM R. 2010 Mar;2(3):174-81. doi: 10.1016/j.pmrj.2010.01.014. PMID: 20359681.
4. Kavanagh BF: Evaluation of the painful total hip arthroplasty. In Joint Replacement Arthroplasty. Morrey BF, ed. New York: Churchill Livingstone, 1991:782.
5. Mcgrory, Brian. (1999). Stinchfield resisted hip flexion test. Hosp Physician. 35. 41-42. This manuscript describes the Stinchfield test for hip pain, and reviews its history, physiology, and application in clinical orthopaedics. Link
6. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.
7. Bruce Reider, AB, MD. The Orthopaedic Physical Examination, 2nd Edition.