The Patrick’s Test, also known by the acronym FABER (Flexion, Abduction, External Rotation), is a common orthopedic screening maneuver used to assess the hip joint, the sacroiliac (SI) joint, and surrounding soft tissues. Its primary purpose is to reproduce a patient’s pain or demonstrate a restriction in movement, helping to differentiate the source of discomfort in the groin, hip, or lower back region. It is one of the standard, initial steps in a physical examination to guide a clinician toward a focused diagnosis.
Understanding the Patrick’s Test Procedure
The Patrick’s Test is performed with the patient lying flat on their back on an examination table. The procedure begins by flexing the hip and knee of the leg being tested, and then the ankle of that leg is placed just above the knee of the opposite leg. This positioning creates a distinctive “figure-four” shape with the tested limb. The clinician then places one hand on the knee of the tested leg and applies gentle, steady downward pressure to push the hip into external rotation and abduction. Simultaneously, the examiner uses their other hand to stabilize the pelvis by placing it on the anterior superior iliac spine (ASIS) of the opposite side. This counter-pressure ensures that the stress is accurately applied to the hip and sacroiliac joints of the tested side.
Defining a Positive Patrick’s Test
A positive result is defined by two primary criteria: the reproduction of the patient’s familiar pain or a restriction in the normal range of motion. The test is considered positive if the patient experiences discomfort when downward pressure is applied, or if the tested knee cannot be lowered close to the examination table. This inability to lower the knee indicates restricted movement, often due to tightness or an underlying joint issue. The location of the elicited pain is the most important factor for interpretation. If the patient reports pain in the groin or anterior hip region, it suggests a pathology within the hip joint itself. Conversely, if the pain is localized to the posterior hip, the buttock, or the sacroiliac region, it points toward an issue outside the hip joint.
Specific Conditions Suggested by the Result
Pain reported in the anterior groin region during the maneuver strongly suggests a problem originating from the internal structures of the hip joint. This localized discomfort is commonly associated with conditions that affect the articular cartilage or soft tissues inside the hip socket. For example, a positive test with anterior pain is seen in cases of hip osteoarthritis, where the joint cartilage is degenerating and causing stiffness.
Intra-articular hip issues like femoroacetabular impingement (FAI) or acetabular labral tears also frequently cause a positive Patrick’s Test with anterior pain. FAI involves abnormal contact between the ball and socket of the hip, and a labral tear is damage to the ring of cartilage surrounding the hip socket. The FABER position stresses both conditions, causing the bone or torn tissue to be pinched, which reproduces the patient’s typical groin pain.
When the patient reports pain concentrated in the posterior pelvic region or buttock, the result points away from the hip joint itself and toward the sacroiliac (SI) joint. The FABER position places a rotational stress on the SI joint, which connects the sacrum to the pelvis. Reproduction of pain in this area indicates possible sacroiliac joint dysfunction or inflammation, often called sacroiliitis.
If the range of motion is restricted (the knee cannot drop down toward the table) but the patient reports no significant pain, the finding often suggests tightness in the muscles surrounding the hip. Structures such as the iliopsoas or piriformis muscles may be tight, limiting the hip’s external rotation and abduction. This distinction suggests a problem related to muscle flexibility rather than a degenerative or structural joint issue.
Context and Next Steps in Diagnosis
The Patrick’s Test functions as a screening tool, helping to narrow down the potential source of a patient’s pain rather than providing a definitive diagnosis. A positive result does not automatically confirm a specific disease, as the test has limitations in both its sensitivity and specificity when used in isolation. For instance, its accuracy for diagnosing a painful sacroiliac joint is considered weak when used alone. Following a positive result, clinicians typically use further diagnostic steps to confirm the suspected pathology. This often involves performing additional physical examination tests that specifically target either the hip joint or the sacroiliac joint. Advanced imaging is often required to gain a clearer picture of the internal structures, such as X-rays to assess for hip osteoarthritis or magnetic resonance imaging (MRI) to visualize soft tissue damage like labral tears or SI joint inflammation. Integrating the Patrick’s Test result with the patient’s medical history and other examination findings is necessary to formulate an accurate diagnosis and treatment plan.