The FADIR test is a commonly used physical examination maneuver in orthopedic and physical therapy settings to assess for potential issues within the hip joint. It serves as a screening tool, helping clinicians determine if a patient’s hip pain originates from a problem inside the joint capsule, known as intra-articular pathology. The maneuver provokes symptoms by placing the hip in a position that often causes discomfort when specific underlying conditions are present. This physical assessment helps guide the need for further diagnostic imaging, such as X-rays or Magnetic Resonance Imaging (MRI), to confirm the precise source of the patient’s hip pain.
Mechanism of the FADIR Test
The name FADIR is an acronym describing the three movements performed on the hip: Flexion, ADduction, and Internal Rotation. To perform the test, the patient lies on their back while the clinician passively bends the hip to approximately 90 degrees of flexion. The leg is then moved across the body’s midline into adduction, and finally, the hip is rotated inward to its end range of motion.
This specific combination of movements mechanically compresses the anterior superior portion of the femoral head against the rim of the acetabulum (the hip socket). The FADIR test intentionally stresses structures located in the front of the hip. A positive result is recorded when this maneuver reproduces the patient’s familiar sharp groin or anterior hip pain, often described as a deep, pinching sensation.
The primary anatomical structures stressed include the acetabular labrum, a ring of cartilage that deepens the hip socket, and the articular cartilage lining the joint surfaces. The force from the combined movements pushes the junction of the femoral head and neck against the acetabular rim, which can effectively pinch or abut any abnormal bone or soft tissue.
Primary Condition Identified: Femoroacetabular Impingement
A positive FADIR test, characterized by sharp groin pain, is the primary clinical indicator for Femoroacetabular Impingement (FAI). FAI is a condition where abnormal contact occurs between the ball (femoral head and neck) and socket (acetabulum) of the hip joint, often damaging the labrum and cartilage.
FAI is categorized into two main types based on the location of the abnormal bone shape, though a combination is common. Cam impingement involves an extra growth of bone on the femoral head and neck junction, causing it to jam into the socket during movement. Pincer impingement involves an overgrowth of the acetabular rim, causing the socket to cover too much of the femoral head.
The FADIR maneuver is effective because the combination of flexion, adduction, and internal rotation directly drives the bony prominence of a Cam lesion or the neck against the over-covered rim of a Pincer lesion. This mechanical abutment causes the sharp pain in the front of the hip. Because FAI is fundamentally a mechanical problem, the test physically replicates the “pinching” that occurs deep within the joint.
A positive FADIR test can also suggest the presence of an acetabular labral tear, which is frequently associated with impingement. The repetitive abutment from FAI often leads to tearing of the labrum, and the compression force of the FADIR test can irritate a torn labrum, causing pain or a “catching” sensation.
Clinical Application and Reliability
The FADIR test is an important part of a thorough physical examination but is intended as a screening tool, not a standalone definitive diagnostic test. The test is valued for its high sensitivity, meaning its ability to correctly identify nearly everyone who actually has a condition like FAI or a labral tear. Studies show the FADIR test has very high sensitivity, often reported up to 99% for excluding intra-articular hip pathology. A negative test makes the presence of FAI highly unlikely.
However, the test often has a lower specificity, which is its ability to correctly identify those without the condition. A positive FADIR test can occur in people who do not have FAI confirmed by imaging, or the pain may be due to other structures like tight muscles or irritated nerves. Some studies suggest that the specificity for FAI can be as low as 5% to 47%.
Because of this high sensitivity but variable specificity, a positive FADIR result indicates that further investigation is necessary. Clinicians combine the FADIR test with other diagnostic maneuvers, such as range of motion assessments and other impingement tests, to build a stronger clinical picture. A definitive diagnosis of FAI or a labral tear requires confirmation through medical imaging, typically X-rays to assess bone shape and an MRI or CT scan to visualize soft tissues.