FADIR Test for Hip
The FADIR (Flexion-Adduction-Internal Rotation) test is performed with the patient supine by passively flexing the hip to 90°, then adducting and internally rotating the hip; a negative test helps rule out hip disease in young and middle-aged active adults with hip-related pain. 1
How to Perform the Test
The patient lies supine on the examination table. The examiner:
- Flexes the hip to 90°
- Adducts the hip (moves it toward the midline)
- Internally rotates the hip
This combined movement creates impingement at the anterior hip joint and increases intracapsular pressure, particularly in the lateral compartment (27.17 ± 42.63 mmHg), which is significantly higher than other provocative maneuvers 2.
What a Positive Result Indicates
A positive FADIR test (reproduction of the patient's hip pain or anterior groin pain) suggests:
- Intra-articular hip pathology including:
- Femoroacetabular impingement (FAI) syndrome
- Acetabular labral tears
- Chondral lesions
- Ligamentum teres pathology
- Acetabular dysplasia/hip instability
However, the test is non-specific and cannot distinguish between these different pathologies 1.
Clinical Utility and Limitations
Diagnostic Accuracy
The FADIR test demonstrates:
- High sensitivity (80-100% depending on the study) 3, 4, 5
- Low specificity (25-47%) 6, 4
- Diagnostic odds ratio: 5.71-7.82 5
This means the FADIR test is best used as a screening tool to rule OUT hip disease when negative, not to rule IN a specific diagnosis when positive 1.
Key Clinical Recommendations from Guidelines
The 2020 International Hip-related Pain Research Network consensus (highest quality guideline evidence) states 1:
- A negative FADIR test helps rule out hip disease (Median consensus score: 9/9, IQR: 8-9)
- The FADIR test is the only clinical test cautiously recommended for screening all hip-related pain conditions
- Imaging should never be used in isolation but must be combined with symptoms and clinical signs
- The test has been examined in several low-quality studies, limiting definitive conclusions about its accuracy
Practical Application Algorithm
When FADIR is NEGATIVE:
- Consider non-hip sources of pain (lumbar spine, pelvis, knee pathology)
- Hip disease is less likely but not completely excluded
When FADIR is POSITIVE:
- Proceed with imaging: AP pelvis and lateral femoral head-neck radiographs first 1
- If radiographs are negative/equivocal and suspicion remains high, obtain MRI or MR arthrography 1
- Combine with other findings: patient history, functional limitations, and range of motion deficits
- Athletes with positive FADIR and ≥3 functional deficits have 5-10 times higher odds of having symptomatic hip pathology 7, 8
Important Caveats
Inter-rater reliability: The FADIR test shows substantial agreement between experienced examiners (kappa >0.6) 4, meaning results are reasonably consistent when performed by trained clinicians.
Pain mechanism: The high intracapsular pressure generated during FADIR (particularly in the lateral compartment) correlates with pain reproduction, so clinicians should perform this test cautiously and stop if severe pain occurs 2.
Population considerations: Most validation studies focus on young to middle-aged active adults (mean age 16-60 years). The test's utility in older adults with degenerative changes or very young children is less established 3.
Cannot stand alone: The FADIR test has very limited ability to confirm FAI syndrome or increase post-test probability sufficiently for definitive diagnosis 1. Always integrate with imaging and patient symptoms before making treatment decisions.