What does a positive Faber test indicate?

What Does a Positive FABER Test Indicate?

A positive FABER test indicates potential hip joint pathology (including labral tears, femoroacetabular impingement, or osteoarthritis), sacroiliac joint dysfunction, or other intra-articular hip conditions, but it has limited diagnostic specificity and must be interpreted alongside other clinical findings and imaging. 1

Diagnostic Significance and Limitations

Primary Clinical Utility

• The FABER (Flexion-ABduction-External Rotation) test, also called the Patrick test, is a provocation maneuver that stresses both the hip joint and sacroiliac joint simultaneously 1, 2
• A positive test (reproducing the patient's pain) suggests hip or SI joint pathology but cannot distinguish between these sources or specify the exact diagnosis 1, 2
• The test demonstrates good inter-rater reliability (kappa 0.63-0.66), meaning different examiners will consistently agree on whether it's positive or negative 3, 4

What the Evidence Shows About Positive Tests

• In patients with confirmed hip pathology undergoing arthroscopy, 88% had positive FABER tests, indicating high sensitivity for detecting hip joint disease 2
• However, the test has low specificity—meaning many patients without significant hip pathology will also test positive 1
• A positive FABER distance test (≥4 cm difference between sides) correlates with higher alpha angles (average 74° vs 68°) in patients with cam-type FAI, with 85% sensitivity for detecting pathological cam morphology 5
• The test is classified as having "high magnitude" diagnostic utility for acetabular dysplasia and hip instability, but with "low precision," placing it in the "cautiously recommended" category 1

Clinical Interpretation Algorithm

When FABER is Positive

1. Localize the pain reproduction: Does the patient feel pain in the groin/anterior hip (suggests intra-articular pathology) or in the posterior pelvis/SI joint region (suggests SI joint dysfunction)? 1, 6

2. Perform complementary tests:

   • Add the FADIR (Flexion-ADduction-Internal Rotation) test—if both are positive, this increases suspicion for FAI syndrome or labral pathology 7, 8
   • Assess passive internal rotation ROM with hip in neutral position—restricted ROM (<20°) with 94% specificity helps rule in FAI syndrome 8
   • Examine for restricted and painful hip quadrant compared to the contralateral side—this was the most consistent finding in patients with confirmed hip pathology 2

3. Obtain appropriate imaging:

   • Start with AP pelvis and lateral femoral head-neck radiographs to assess bony morphology (cam/pincer deformities, dysplasia, osteoarthritis) 1, 6
   • If radiographs are negative but clinical suspicion remains high, proceed to MRI or MR arthrography to evaluate labrum, cartilage, and ligamentum teres 1, 7
   • Never diagnose based on imaging alone—incidental findings are extremely common in asymptomatic individuals 1, 7

Critical Pitfalls to Avoid

• Do not assume a positive FABER test confirms hip joint pathology without ruling out SI joint dysfunction, lumbar spine pathology, or other pelvic sources 1, 6, 7
• Do not use the FABER test in isolation—it should be part of a comprehensive hip examination including ROM assessment, impingement tests, and strength testing 1, 2, 8
• Beware of contralateral pain with FABER testing—this suggests SI joint dysfunction rather than primary hip pathology 6
• A negative MRI does not exclude hip pathology if clinical suspicion is high; hip arthroscopy may still be indicated 2

Specific Conditions Associated with Positive FABER

Hip Joint Pathology

• Labral tears (50% of patients in surgical series) 4
• Femoroacetabular impingement (69% of patients in surgical series) 4
• Hip osteoarthritis (39% of patients in surgical series) 4
• Capsular laxity/instability (40% of patients in surgical series) 4

Extra-articular Conditions

• Sacroiliac joint dysfunction 1, 6
• Iliopsoas tendonitis (14% of patients in surgical series) 4
• Trochanteric bursitis (41% of patients in surgical series) 4

Practical Clinical Recommendations

For young and middle-aged active adults with positive FABER test and hip-related pain:

• Categorize into three potential groups after imaging: (1) FAI syndrome, (2) acetabular dysplasia/hip instability, or (3) other hip-related pain conditions without specific bony morphology 1, 7
• Initiate conservative management with education and prescribed physiotherapy as first-line treatment 7
• Consider diagnostic/therapeutic intra-articular hip injection if conservative treatment fails after 6-8 weeks to confirm the hip as the pain generator 6, 7
• Screen systematically for competing diagnoses including lumbar spine pathology, SI joint dysfunction, and serious pathology (tumors, infections, stress fractures) 7, 9

In children under 5 years presenting with limp:

• The FABER test (also called Patrick test) helps localize pathology to the hip or pelvis 1
• Positive test warrants imaging starting with radiographs, with ultrasound reserved for suspected developmental dysplasia or septic arthritis 1