From the Guidelines
A positive figure 4 test indicates irritation or pathology in the hip joint, sacroiliac joint, or lower back, suggesting possible conditions such as hip osteoarthritis, femoroacetabular impingement, labral tears, sacroiliac joint dysfunction, or lower back pathology. This test is performed by placing the patient's ankle on the opposite knee in a figure-4 position and gently pressing down on the flexed knee while stabilizing the opposite hip. Pain elicited during this maneuver suggests several possible conditions, and while a positive test is sensitive for detecting hip problems, it is not highly specific for any single condition, so additional diagnostic tests such as imaging or other provocative maneuvers are typically needed to confirm the exact diagnosis 1.
The figure 4 test specifically stresses the hip in flexion, abduction, and external rotation, which can reproduce symptoms when there is intra-articular hip pathology. Some key points to consider when interpreting the results of a figure 4 test include:
- The test is valuable as a screening tool in the initial physical examination of patients presenting with hip, groin, or lower back pain.
- Additional diagnostic tests, such as imaging or other provocative maneuvers, are typically needed to confirm the exact diagnosis.
- The test is sensitive for detecting hip problems, but not highly specific for any single condition.
- The test can help identify possible conditions such as hip osteoarthritis, femoroacetabular impingement, labral tears, sacroiliac joint dysfunction, or lower back pathology.
It's also important to consider the limitations of the figure 4 test, including:
- The test may not be highly specific for any single condition.
- The test may not be able to rule out other possible causes of hip pain.
- Additional diagnostic tests may be needed to confirm the exact diagnosis.
Overall, the figure 4 test is a useful tool in the diagnosis of hip-related pain, but should be used in conjunction with other diagnostic tests and a thorough physical examination to confirm the exact diagnosis 1.
From the Research
Hip Exam Tests
- The figure 4 test is used to assess for hip pathology, specifically femoroacetabular impingement (FAI) and hip labral tears 2.
- A positive figure 4 test indicates pain or limited range of motion in the hip, suggesting possible hip joint or labral pathology 3, 4.
- The test is performed with the patient in a supine position, bringing the hip into flexion, adduction, and internal rotation, which can help to identify issues with the hip joint or surrounding tissues 3.
Clinical Examination
- Clinical examination tests, including the figure 4 test, are helpful but not highly sensitive or specific for most diagnoses 4.
- A comprehensive physical examination of the hip, including a range of tests and maneuvers, can help to identify hip pathology and guide further diagnosis and treatment 3, 2.
- The figure 4 test is one of several tests that can be used to evaluate the hip, and its results should be considered in conjunction with other clinical findings and diagnostic tests 3, 4.
Diagnostic Tests
- Radiography, including anteroposterior and frog-leg lateral views, can be used to evaluate the hip for fractures, dislocations, or other bony abnormalities 4.
- Magnetic resonance imaging (MRI) can be used to detect occult traumatic fractures, stress fractures, and osteonecrosis of the femoral head, as well as to evaluate the hip labrum and surrounding tissues 4.
- The figure 4 test can be used as part of a comprehensive physical examination to help guide further diagnostic testing and treatment 3, 2.