The Stinchfield test is a physical examination maneuver healthcare providers use to evaluate pain originating in the lower abdomen or the hip joint. This simple, non-invasive assessment is performed when a patient presents with discomfort in the groin or abdominal area, suggesting potential musculoskeletal or intra-abdominal pathology. A positive result does not provide a final diagnosis, but rather directs the clinician toward the source of irritation.
Understanding the Stinchfield Maneuver
The Stinchfield maneuver, sometimes called the resisted hip flexion test, is designed to stress the iliopsoas muscle group. The patient lies flat on their back and is asked to lift their leg straight up against the downward resistance applied by the examiner. This action forces a forceful contraction of the iliopsoas muscles, which are the primary hip flexors. Requiring the patient to actively resist this external pressure significantly increases the tension and compression forces around the hip.
The iliopsoas muscle group is positioned deep within the abdomen and pelvis. It consists of the psoas major and the iliacus muscles, which merge to cross the hip joint. This deep location means the muscle lies directly adjacent to several retroperitoneal structures, including the appendix, ureters, and lymph nodes. Consequently, contracting this muscle can compress or irritate any inflamed structure lying next to it.
Defining a Positive Result
A positive Stinchfield test is defined as the reproduction of pain in the patient’s hip, groin, or lower abdominal region during the resisted straight leg raise. The location of the pain is a significant clue that helps guide the diagnosis.
Pain localized to the anterior groin suggests a primary issue within the hip joint itself, such as inflammation or a tear. Conversely, pain localized to the lower abdominal quadrant, especially the right side, suggests that the contracting muscle is irritating an adjacent, inflamed organ. This positive finding acts as an indicator of irritation or inflammation in the deep structures that are in close proximity to the iliopsoas muscle sheath.
Implications for Diagnosis
A positive response to the resisted hip flexion maneuver can suggest several distinct conditions, depending on the precise location of the patient’s pain.
Musculoskeletal and Intra-Articular Causes
When the pain is felt in the anterior hip and groin, the most common causes relate to the musculoskeletal system. These include conditions like iliopsoas tendinitis, which is inflammation of the tendon itself, or a direct strain or tear within the muscle fibers from trauma or overuse.
The test is also used to help distinguish pathology originating inside the hip joint, known as intra-articular causes, such as arthritis, a labral tear, or a fracture. The forceful contraction of the iliopsoas muscle creates a powerful compression force that stresses the hip joint. This mechanical loading can reproduce pain if the joint surfaces or internal structures are damaged or inflamed.
Abdominal and Infectious Causes (Psoas Sign)
When the pain is experienced in the lower abdominal quadrant, the positive Stinchfield test takes on a different meaning, often referred to as a positive Psoas Sign. This is most commonly associated with acute appendicitis, particularly when the appendix is positioned retrocecal, meaning it lies behind the cecum and directly against the right psoas muscle. When the inflamed appendix rubs against the tensed muscle, it causes sharp right-sided abdominal pain.
Infectious conditions, such as a psoas abscess, also frequently yield a positive result. This is a collection of pus and infection directly within the muscle sheath, which is intensely painful when the muscle contracts. Furthermore, other inflammatory conditions of the gastrointestinal or urinary tracts may irritate the muscle, including diverticulitis, regional enteritis, or certain urological issues.
The Stinchfield test acts as a general indicator of deep inflammation, but it is not a standalone diagnostic tool. A definitive diagnosis always requires further investigation, such as blood tests to check for infection markers and medical imaging like ultrasound or CT scans to visualize the affected organs.