Aula 08 - RADIOLOGICAL EXAMINATION OF THE HIP - CLINICAL INDICATIONS, METHODS, AND INTERPRETATION - A CLINICAL COMMENTARY

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ABSTRACT
There is a growing interest in musculoskeletal rehabilitation for young active individuals with non-arthritic 
hip pathology. History and physical examination can be useful to classify those with non-arthritic intra-
articular hip pathology as having impingement or instability. However, the specific type of deformity lead-
ing to symptoms may not be apparent from this evaluation, which may compromise the clinical 
decision-making. Several radiological indexes have been described in the literature for individuals with 
non-arthritic hip pathology. These indexes identify and quantify acetabular and femoral deformities that 
may contribute to instability and impingement. The aim of this paper is to discuss clinical indications, 
methods, and the use of hip radiological images or radiology reports as they relate to physical examination 
findings for those with non-arthritic hip pathology.
Level of evidence: 5
Key words: Examination, Femoroacetabular impingement (FAI), imaging, labrum
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CLINICAL COMMENTARY
RADIOLOGICAL EXAMINATION OF THE 
HIP  CLINICAL INDICATIONS, METHODS, AND 
INTERPRETATION: A CLINICAL COMMENTARY 
Amir C. Reis, PT, MSc Candidate1
Nayra D.A. Rabelo, PT, MSc Candidate1
Rafael P. Pereira, PT2
Giancarlo Polesello, MD, PhD3
Robroy L. Martin, PT, PhD4,5
Paulo Roberto Garcia Lucareli, PT, PhD6
Thiago Y. Fukuda, PT, PhD2,7
1 MSc postgraduate student, Universidade Nove de Julho, São 
Paulo, SP, Brazil
2 Irmandade da Santa Casa de Misericórdia, Rehabilitation 
Service, São Paulo, SP, Brazil
3 Irmandade da Santa Casa de Misericórdia, Orthopaedic and 
Traumatologic Department, São Paulo, SP, Brazil
4 Duquesne University, Pittsburgh, PA, USA
5 University of Pittsburgh Centers for Sports Medicine, 
Pittsburgh, PA, USA
6 Professor at Universidade Nove de Julho, Rehabilitation 
Service, São Paulo, SP, Brazil
7 Centro Universitário São Camilo, São Paulo, SP, Brazil
CORRESPONDING AUTHOR
Thiago Yukio Fukuda
Rua Dr. Cesário Motta Jr (Setor de 
Fisioterapia), 112, CEP: 01221-020
São Paulo, SP, Brazil
Email: tfukuda10@yahoo.com.br
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INTRODUCTION
There is a growing interest in musculoskeletal reha-
bilitation for young active individuals with non-
arthritic hip pathology. Physical therapists generally 
base their assessment of those with hip pathology 
on history and physical examination.1 However, 
bony abnormalities may influence the patient’s 
prognosis and therefore may need to be identified. 
When abnormalities of bone morphology are pres-
ent, direct repercussions on the biomechanics of the 
hip and adjacent joints can occur.2 Several radiologi-
cal indexes have been described in the literature for 
individuals with non-arthritic hip pathology.3,4 The 
aim of this paper is to discuss clinical indications, 
methods, and interpretation of hip radiological 
images as they relate to physical examination find-
ings for those with non-arthritic hip pathology.
There are a limited number of evaluation algorithms 
for those with hip related symptoms. An evaluation 
algorithm and classification based treatment sys-
tem have recently been described to guide physical 
therapists in the management of individuals with 
hip pain, including those with non-arthritic related 
pathology.5,6 This evaluation includes considerations 
for non-musculoskeletal, lumbosacral spine, extra-
articular, and intra-articular sources of pain. Intra-
articular pathologies for individuals with non-arthritic 
hip pain are further classified as impingement and 
hypermobility as outlined in Figure 1. While evidence 
to support the use of this algorithm is lacking it does 
relate to relevant non-arthritic radiographic abnor-
malities that have been described.
History and physical examination are commonly 
used to assess for non-musculoskeletal and lumbosa-
cral spine pathology as potential sources of hip pain 
as described in detail elsewhere.5-12
Once non-musculoskeletal and lumbar spine pathol-
ogy are ruled out as potential sources of hip pain, the 
clinician must determine if there is an intra- and/
or extra-articular source of symptoms. The Flex-
ion-Abduction-External Rotation (FABER), Internal 
Range of Motion with Over-Pressure (IROP), and 
Scour tests may be useful in this capacity.13-15 The 
FABER and IROP tests have sensitivity values in 
identifying individuals with intra-articular pathol-
ogy of 0.82 and 0.91, respectively.14
The Scour test has sensitivity values ranging between 
0.62 and 0.91 in identifying those with intra-articular 
pathology.13,15 Extra-articular pain generators, such 
as musculotendinous pathologies, should not be pro-
voked with the FABER, IROP, and Scour tests. Mus-
culotendinous pathologies, including muscle strains 
and/or tendon disorders, should be painful with pal-
pation, stretching, and resisted movements directed 
at the involved muscle and/or tendon. If the source 
of pain is solely from intra-articular origin, palpable 
pain is rarely present.16 If FABER, IROP, and Scour 
tests are positive, the source of pain is likely due 
to intra-articular sources.7,17 Once it is determined 
that the source of pain is intra-articular, additional 
tests can be conducted in order to further classify 
individuals into an impingement or hypermobility 
classification.
FEMOROACETABULAR IMPINGEMENT
Two types of femoroacetabular impingement (FAI) 
have been described; cam and pincer types.18 Cam 
impingement results from an abnormal bump, thick-
ening, and/or loss of femoral-head neck offset which 
can be localized anteriorly, superiorly, posteriorly, 
and/or inferiorly.19 Cam deformities cause labral 
compression and sheer forces leading to acetabular 
cartilage damage.19,20 The location of the deformity 
and direction of hip movement will determine the 
specific location of injury. A cam deformity at the Figure 1. Evaluation algorithm for young active individuals.
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anterior-superior femoral head-neck junction will 
compress the anterior-superior labrum during the 
combined motion of hip internal rotation, flexion, 
and adduction. Posterior head-neck deformities can 
cause posterior-superior labral compression with 
hip external rotation and extension, while head-neck 
deformities that are located superiorly can cause 
superior labral compression with hip abduction.21
Differing from cam impingement, pincer type 
impingement results from an acetabular deformity. 
Focal or global over coverage of the femoral head by 
the acetabulum are terms used to further describe 
pincer impingement.19 Superior focal over coverage 
results from the anterior and superior acetabular 
rim extending laterally over the femoral head. This 
deformity can cause the femoral head-neck junction 
to abut the anterior-superior labrum when the hip 
moves into internal rotation, flexion, and adduction.21 
Excessive acetabular retroversion and anteversion 
are also potential causes of focal over coverage. Ace-
tabular retroversion results in anterior over coverage 
but posterior under coverage of the femoral head. 
This anterior over coverage will cause the head-neck 
junction to come into contact with anterior-superior 
labrum when the hip is internally rotated in flexion. 
Conversely, acetabular anteversion causes posterior 
over coverage but anterior under coverage with the 
head-neck junction abutting the posterior-superior 
labrum in a position of hip external rotation and 
extension.21 Coxa profunda and protrusio are acetabu-
lar global over coverage deformities.19 Depending on 
the severity of the over coverage, labral damagefrom 
compression can occur in locations where the head-
neck junction comes into contact with the labrum. 
Acetabular deformities can also cause the femoral 
head to be levered out of the acetabulum and result 
in cartilage and/or labral pathology in a location 
opposite to the labral compression. These types of 
injuries are called ‘countra-coup’ lesions.22,23
In addition to cam and pincer type FAI, mechanical 
impingement may be caused by rotational deformi-
ties of the femur in the transverse plane.24 The fem-
oral head-neck is normally rotated approximately 
15� anteriorly. Decreased anteversion is noted when 
the femoral head-neck is rotated less than 15�. The 
anterior-superior head-neck junction will be closer 
to the anterior rim of the acetabulum when angle 
of anteversion is decreased. Therefore, movements 
that incorporate hip internal rotation in 30-60� of 
flexion may cause the femoral head-neck junction 
to compress the anterior-superior labrum. Exces-
sive femoral anteversion is said to be present when 
the femoral head-neck is rotated greater than 15� 
anteriorly. When anteversion is greater than 30� the 
posterior head-neck junction will be close to the pos-
terior rim of the acetabulum and compress the pos-
terior-superior labrum with the femoral head-neck 
junction with combined hip external rotation and 
extension.21
Prospective studies have demonstrated potential 
diagnostic indicators of FAI. These studies have 
found those with FAI commonly complain of an 
insidious onset of sharp or aching groin pain that 
limits activity.25,26 Those with FAI also have physical 
examination findings of limited hip flexion, internal 
rotation, and abduction range of motion and positive 
Flexion-Adduction-Internal Rotation Impingement 
(FADDIR) and FABER tests.4,27-29
Special tests to identify the specific source of 
impingement as either anterior, superior, and/or 
posterior have been developed and include two 
dynamic impingement tests.30 The Dynamic Internal 
Rotation Impingement test (DIRI) circumducts the 
hip through an arc of flexion, adduction, and inter-
nal rotation in order to cause contact of the femoral 
head-neck junction with the anterior and anterior-
superior rim of acetabulum.30 The dynamic external 
rotation impingement test (DEXTRI) circumducts 
the hip through an arc of extension, abduction, and 
external rotation in order to cause contact of the fem-
oral head-neck junction with the posterior and pos-
terior-superior rim of acetabulum.30 The position(s) 
that recreate the pinching pain can be used to iden-
tify the potential location of impingement. 
While the DIRI and DEXTRI have been described to 
potentially assess for the source of Cam and Pincer 
impingements, Craig’s test may be used to identify 
those with abnormal femoral version. This method 
involves positioning an individual prone and flex-
ing the knee to 90 degrees. The greater trochanter is 
then palpated as the thigh is internally and externally 
rotated, until the greater trochanter is at its most 
prominent position laterally. Femoral anteversion is 
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measured as the angle formed by the long axis of the 
lower leg and the vertical, and is quantified using 
a goniometer or inclinometer.31 A normal test is a 
position of 15� hip internal rotation when the greater 
trochanter is parallel to the floor/table. Individuals 
in a position of more than approximately 15� may be 
considered to have increased femoral anteversion, 
which would lead to a greater anterior exposure of 
the femoral head.
INSTABILITY
Labral-chondral pathology can also be caused by 
either focal rotational or global hip laxity.32 Although 
there are many causes of instability27 in a young 
active population, localized laxity of ligamentous and 
capsular structures is commonly caused by excessive 
repetitive forceful hip rotation. This type of injury 
is defined as focal rotational instability.33-35 The most 
common injury is iliofemoral ligament laxity caused 
by repetitive forceful hip external rotation beyond 
the limit of normal motion. Although less common, 
excessive internal rotation could potentially lead 
to ishiofemoral ligament laxity.30 Instability is usu-
ally combined with some form of acetabular under-
cover.36 This can be from acetabular anteversion, 
retroversion, or global under coverage. Although 
any malformation of the acetabular shape could be 
termed dysplasia, hip dysplasia is a term commonly 
associated with global under coverage resulting from 
a shallow acetabulum. Abnormal loading of the ante-
rior-superior labrum and subsequent labral-chon-
dral damage can occur with either focal rotational 
or global hip laxity.34,35,37 Regarding the femoral head 
neck deformities, coxa valgum may also lead to insta-
bility and abnormal loading of the superior labrum, 
thus contributing to labral-chondral pathology(38,39).
The diagnosis of instability can be suspected when 
complaints of hip pain are associated with findings 
of hypermobility. Individuals may note movement 
dependent hip instability or apprehension. Clini-
cally, range of motion measurements, the log roll 
test, and Beighton Scale can be used to assess for 
hypermobility. Hip range of motion measures that 
exceed established normative values or that are 
increased compared to the uninvolved side without 
the presence of an anteverted or retroverted femur 
should raise suspicion of hypermobility. Signs for 
select iliofemoral ligament laxity include increased 
hip external rotation but normal internal rotation 
range of motion.40 The log roll test specifically 
assesses rotational motion and is used to observe 
asymmetrical increases in internal and external 
rotation as well as quality of end-feel.30 Excessive 
external rotation motion with softer than normal 
end-feel would indicate iliofemoral ligament laxity. 
Additionally, the Beighton Scale can be used to iden-
tify those with general ligament laxity.41 Using this 
scale three or more of the following would indicate 
general ligament laxity: extension of the 2nd meta-
carpal phalangeal joint beyond 90�, flexion of the 
thumb to the forearm, extension of the knee beyond 
10�, extension of the elbow beyond 10�, and palms 
touching the floor while bending at the waist.
History and physical examination can be useful to 
classify young active individuals with non-arthritic 
hip pathology as having impingement or instability. 
However, the specific type of deformity leading to 
symptoms may not be apparent from this evalua-
tion. For example, an individual may have signs and 
symptoms consistent with impingement, including 
a positive DIRI. While FAI would be suspected, the 
bony deformity being an anterior-superior cam, ace-
tabular retroversion, or global over coverage, may 
be difficult to determine solely from the physical 
examination. Also, prognosis for conservative care 
may be linked to the degree of boney deformity. An 
individual with signs and symptoms consistent with 
instability and excessive global acetabular under cov-
erage may have a worse prognosis than an individual 
with similar signs and symptoms but only a slight 
degree of under coverage. Therefore, physical thera-
pists may use the results of radiographic assessment 
of acetabulum and femur to help verify the classifica-
tion; more precisely identify the type of bony defor-
mity, and assist in determining a potential prognosis 
based on the degree of the deformity.17 While there 
are not absolute values that define how the degree of 
deformity will relate to prognosis, severe deformities 
are likely to be associated less favorable outcomes.
RADIOGRAPHIC ASSESSMENT
Radiographic examination is widely used because it 
is readily available, simple, and fairly inexpensive. 
However, as with any tool it must be performed 
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properly. Standard conventional radiographic imag-
ing for femoroacetabular investigation includes two 
radiographs: an anteroposterior (AP) view and an 
axial cross-table view.4 Some alternatives to the axial 
view are the Ducroquet and Dunn radiographs and 
because they provide similar information which 
will not be discussed. In the case of an anteropos-
terior (AP) X-ray, neutral rotation of the pelvis in 
the transverse plane is defined when the lower end 
of the coccyx is located perpendicular to the pubic 
symphysis (Figure 2). In relation to sagittal plane, 
neutral pelvic inclination is established when the 
distance between the coccyx and pubic symphysis is 
approximately 3 cm for men and 5 cm for women.4,42 
Determining that the radiograph was taken with 
neutral pelvic inclination is critical and must be 
done before the radiograph can be interpreted. An 
AP radiograph that does not follow this standard-
ization cannot reliably diagnose boney deformities 
of the hip joint.4 The cross-table radiograph is per-
formed with the hip in neutral position or internally 
rotated at 15 degrees in order for the femoral neck-
head junction to be appropriately visualized.43
ACETABULAR CONDITIONS
Acetabular depth
The AP radiograph can be used to identify abnor-
mal acetabular morphology in terms of focal or 
global over or under coverage (Figure 3). There are 
a number of indexes that can be used to assist in 
quantifying acetabular depth and include acetabular 
index (also known as acetabular roof angle), femoral 
head extrusion index and lateral center edge angle 
of Wiberg.44,45
The acetabular index in the AP X-ray (Figure 3) is 
determined by making a horizontal line from the 
most medial point of the sclerotic zone of the ace-
tabulum (line A). Another line is placed from this 
same point to the lateral edge of acetabulum (line 
B). When the angle formed by these two lines is 
equal or less than 0� superior focal over coverage of 
the acetabulum is suggested.46
The femoral head extrusion index (Figure 3) is deter-
mined by measuring the distance between a vertical 
line over the most medial point of the sclerotic zone 
of the acetabulum and a vertical line over the lateral 
most edge of the acetabulum. The distance between 
these two lines in the frontal plane corresponds to 
line A. Another vertical line is placed from the femo-
ral head-neck junction and the distance between this 
point and the vertical line over the lateral edge of 
the acetabulum corresponds to line B. The distance 
of line B is then divided by the distance of lines A+B 
and a percentage is created. This index defines the 
percentage of the femoral head that is without acetab-
ular coverage. Femoral head extrusion index greater 
than 25% would indicate global undercoverage.19,44
The lateral center edge angle of Wiberg (Figure 3) 
is created between a vertical line from the center of 
the femoral head (line A) and a line connecting the 
Figure 2. Anteroposterior X-ray of the pelvis in neutral position (A). The black line indicates the distance between the coccyx and the 
public symphysis. The acceptable distance is considered to be between 3 and 5 cm (B).
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center of the femoral head with the lateral edge of 
the acetabulum (line B). The angle formed is nor-
mally between 25� and 39�. Values less than 25� indi-
cate global acetabular under coverage where values 
above 39� indicate superior focal over coverage or 
excessive global acetabular over coverage.24,44-47
As previously noted, excessive acetabular retrover-
sion and anteversion result in focal over coverage 
in one direction and under coverage in the opposite. 
An increased anterior wall characterizes an acetab-
ular retroversion and is detected by the cross-over 
sign in an AP X-ray of the hip. In those with ana-
tomically normal acetabular anteversion, the edge 
of the anterior wall (line A) is visualized medially in 
relation to the posterior wall (line B) (Figure 4). In 
the case of an acetabular retroversion, the anterior 
wall is more lateral than the posterior wall and then 
crosses it medially and noted as a positive cross-over 
sign (Figure 4).42,44,48
Coxa profunda and protrusio as noted are acetabu-
lar deformities that cause global over coverage. Coxa 
profunda is defined radiographically when the tear-
dropped shaped articular surface of the acetabulum 
lies medial to the ilioischial line from an anterior-pos-
terior view. Protrusio refers to a medialization of the 
femoral head position within the acetabulum.19,49 In 
the AP image, the line traced over the medial wall of 
the acetabulum (line A) would normally be visualized 
laterally to the ilioischial line (line B). When line A 
touches or surpasses line B, it is classified as a coxa pro-
funda.4 The protrusio index is determined by tracing 
a line over the medial extremity of the femoral head 
(line C), which would normally be visualized laterally 
to the ilioischial line (line B). When the line over the 
femoral head surpasses the ilioischial line medially, 
this is classified as acetabular protrusio (Figure 5).4,50
Evidence for interpretation of acetabular 
deformities
Several authors have discussed the validity of these 
indices, as well as the frequency at which they are 
found in symptomatic and asymptomatic popula-
tions. When those with a surgically identified labral 
tear were compared to controls, Peelle et al51 found 
a larger acetabular index (9.6� vs 6.2�; p=0.02), but 
no difference in lateral center edge angle of Wiberg 
and acetabular retroversion. The Wiberg angle 
and retroversion may better correlate to the pres-
ence of osteoarthritis.52 A Wiberg angle higher than 
45�, i.e., a deep acetabular socket, was considered 
a risk factor for hip osteoarthritis.53 Corroborating 
Figure 3. A) Anteroposterior X-ray of a normal hip; B) Acetabular index–angle formed by a horizontal line (line A) and a line connect-
ing the medial point of the sclerotic zone with the lateral edge of the acetabulum (line B); C) Femoral head extrusion index–line C corre-
sponding to the connection of both extremities of the acetabulum esclerotic zone and line D corresponding to the connection of the femoral 
head-neck junction and the sclerotic zone of the acetabulum; and D) Lateral center edge angle of Wiberg–a vertical line from the femoral 
head center (line E) and a line connecting the femoral head center with the lateral edge of the acetabulum (line F).
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this information, Ezoe et al54 showed that subjects 
with osteoarthritis were more likely to have acetab-
ular retroversion than are normal subjects. Radio-
graphic acetabular retroversion was present in 20% 
of patients with hip osteoarthritis compared to 5-7% 
among the general population.
FEMORAL CONDITIONS
Cam quantifi cation
The cam type impingement is identified in the 
cross-table radiographic views and quantified by 
measuring the alpha angle and anterior offset dis-
tance.22,44,55 Figure 6 displays the measurement of 
Figure 4. Anterosposterior X-ray of normal hip (A)–anterior wall (line A) being projected more medially than posterior wall (line B); 
Acetabular retroversion (B)–anterior wall (line C) being more lateral than posterior wall (line D), i.e., showing a crossover sign.
Figure 5. Anterosposterior X-ray–A) The acetabular fossa line (line A) overlapping the ilioischial line medially (line B), indicating a 
coxa profunda; and B) The femoral head line (line C) touching or overlapping the ilioischial line medially(line D), indicating an acetabu-
lum protusio.
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the alpha angle. The circumference of the femoral 
head is first outlined. Then, a line is traced (A) from 
the center of the femoral head towards the central 
neck region. Another line (B) is traced from the cen-
ter of the femoral head to the point where the neck 
ends and the sphericity of the femoral head begins. 
The angle formed by the two lines is normally less 
than 50�.4,28,56,57 Values greater than 50� indicate an 
enlarged anterior-superior femoral head-neck junc-
tion. A greater alpha angle has been also identified 
in those with clinical signs of impingement,58 labral 
tears,28,51,59 acetabular rim chondral defects, and 
osteoarthritis28 when compared to asymptomatic 
controls.
The femoral anterior offset distance (Figure 6) is an 
index that is defined by the distance between the 
anterior the femoral head and anterior femoral neck. 
This distance is measured between a horizontal line 
at the most superior point of the femoral head (line 
A) and another horizontal line at the point where 
the femoral head ends and the neck begins (line B). 
The perpendicular distance (line C) between the 
two lines is the anterior femoral offset distance. An 
offset less than 10 mm also indicates an enlarged 
anterior-superior femoral head-neck junction.4,44,57 
Cervico-diaphyseal angle
The femoral neck is tilted upwards in relation to the 
diaphysis of the femur at an angle of approximately 
125� during adulthood. This cervico-diaphyseal angle 
can be determined by an AP radiograph. It is the 
angle formed by the axis of the femoral shaft (line 
A) and a line drawn along the axis of the femoral 
neck passing through the femoral head center (line 
B) (Figure 7).3,60 If a subject exhibits a cervico-diaph-
yseal angle less than 120�, it is classified as coxa vara, 
whereas an angle greater than 130� is classified as 
a coxa valga61 Coxa vara is thought to be associated 
with instability and coxa valga associated with ante-
rior superior labral tears.
Figure 6. Cross-table X-ray of the right hip (A); Alpha angle (B)–circumference of the femoral head; line A which connects the head 
center of the femoral neck and line B connecting the head center witht the point of beginning asphericity of the head-neck junction. An 
angle exceeding 50� is an indicator of an abnormally shaped femoral head-neck junction; Anterior offset (C)–two horizontal lines touching 
the anterior femoral head (line C) and femoral head-neck junction (line D). The distance between both lines corresponds to the anterior 
offset (line E).
Figure 7. Cervico-diaphyseal angle–it is the angle formed by 
the axis of the femoral shaft (line A) and the line a drawn along 
the axis of the femoral neck passing through the femoral head 
center (line B).
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Evidence for Interpretation of Femoral 
Deformities
An alpha angle higher than 50.5º had sensitivity and 
specificity values of 72% and 100%, respectively, in 
identifying those with clinical signs of impingement 
from controls.55 Patients with a clinical exam con-
sistent with FAI showed a significant reduction in 
head-neck offset in the lateral and anterior aspect of 
the femoral neck.62 However it is important to high-
light that this study used an MRI-assessment.
INTEGRATION OF CLINICAL AND 
RADIOGRAPHIC ASSESSMENT
It is important to highlight the necessity of using 
radiographs in conjunction with physical exam find-
ing because the imaging findings are not always 
related to the presence of pain, and vice-versa. A 
summary relating the sign, radiographic measures 
and interpretation can be found in Table 1. Related 
to acetabular conditions, a recent study conducted 
by Kang et al63 evaluated 100 hips in asymptomatic 
population and found an increased Wiberg angle 
in 16%, acetabular retroversion in 14%, and posi-
tive cross-over sign in 20% of subjects. Moreover, 
Tannast et al4 evaluated the cross-over sign in 55 
patients with FAI and it was present in only 53% of 
hips. Although, the cross-over sign had a sensitivity 
of 71% and specificity of 88% for hip impingement, 
the authors noted that this sign by itself was not 
enough to diagnose FAI. Similarly, femoral changes 
found in radiological analysis are not sufficient to 
ensure the presence of pain or functional deficits. 
Kang et al63 also found an increased alpha angle in 
10% of the hips and changes in the femoral head 
sphericity in 74% of asymptomatic population. In 
clinical terms, the bone abnormalities may provoke 
Table 1. Physical Exam Findings, Radiographic Findings, and Interpretation in Young Active Individuals with Non-Arthritic 
Hip Pain
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The International Journal of Sports Physical Therapy | Volume 9, Number 2 | April 2014 | Page 265
pain by causing repetitive microtrauma in the hip 
joint, especially in subjects with abnormal move-
ment patterns of lower limbs during physical activ-
ity of functional tasks.4,21,61,64-66 Clinicians should be 
aware of the large number of false positive findings 
associated with the radiographic measures discussed 
in the paper. This exemplifies the notion that radio-
graphic findings must be used in conjunction with 
history and clinical examination in order to be prop-
erly interpreted.
CONCLUSION
History and physical examination can be useful to 
classify young active individuals with non-arthritic 
intra-articular hip pathology as having impingement 
or instability. However, the specific type of defor-
mity leading to symptoms may not be apparent 
from this evaluation. Several radiological indexes 
have been described in the literature for individuals 
with non-arthritic hip pathology. The paper outlines 
the clinical indications, methods, and interpretation 
of hip radiological images as it relates to physical 
examination findings for those with non-arthritic 
hip pathology.
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 /ITA <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>
 /NOR <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>
 /SVE <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>
 >>
>> setdistillerparams
<<
 /HWResolution [2400 2400]
 /PageSize [657.000 855.000]
>> setpagedevice