What is the significance of a positive Beer and Hawkins test in a patient with a history of orthopedic or musculoskeletal issues?

Significance of Positive Beer and Hawkins Testing

Critical Clarification: Test Name Correction

The "Beer test" and "Hawkins test" are shoulder impingement tests, not hip tests. If you are asking about hip pathology (given the context of orthopedic/musculoskeletal issues and the evidence provided), you likely mean the FABER test (Flexion-Abduction-External Rotation, also called Patrick's test) or other hip-specific provocative maneuvers 1, 2.

If You Mean Hip Tests (FABER/Patrick's Test)

Clinical Significance

A positive FABER test suggests intra-articular hip pathology, most commonly acetabular labral tears, femoroacetabular impingement (FAI), or hip joint inflammation, and warrants further diagnostic workup with MR arthrography. 1, 2

Diagnostic Performance

• FABER test sensitivity: 88% for detecting hip joint pathology when compared to arthroscopic findings, making it a useful screening tool 2
• The test is classified as having high magnitude but low precision for diagnosing hip-related conditions, meaning it provides meaningful diagnostic information but with wider confidence intervals 1
• Specificity varies depending on the underlying pathology being assessed, with the test being more useful when combined with other clinical findings 1

What a Positive Test Indicates

• Labral pathology: The most common finding in patients with positive FABER tests, particularly anterior labral tears 3, 4, 2
• FAI syndrome: Reduced hip internal rotation combined with positive FABER suggests cam or pincer impingement 5
• Hip joint inflammation: Including septic arthritis, inflammatory arthritis, or reactive synovitis 1
• Acetabular dysplasia or hip instability: When combined with other provocative tests 1

Clinical Algorithm for Positive FABER Test

Step 1: Confirm the finding

• Assess for restricted and painful hip quadrant compared to contralateral side—this is the most consistently positive finding in hip pathology 2
• Measure supine hip internal rotation—reduced ROM suggests FAI 5
• Perform additional provocative tests: Scour test for labral tears, FADIR/impingement test for FAI 6, 5

Step 2: Rule out infection if acute presentation

• Obtain ESR, CRP, and joint aspiration if there is acute onset, fever, or systemic symptoms 1, 7
• ESR >70 mm/h has 81% sensitivity and 80% specificity for osteomyelitis in appropriate clinical context 8
• Do not rely on normal peripheral WBC count to exclude infection, as most patients with septic joints have normal WBC counts 7, 9

Step 3: Obtain imaging

• Plain radiographs first to assess for dysplasia, degenerative changes, fracture, or other bony pathology 1, 4
• MR arthrography (MRA) is the diagnostic test of choice for labral tears and intra-articular pathology, with significantly higher sensitivity than standard MRI 4, 2
• Note that MRA has 100% specificity but lower sensitivity with relatively high false-negative rates, so negative MRA does not exclude hip pathology if clinical suspicion remains high 2

Step 4: Consider arthroscopy

• Hip arthroscopy is the gold standard for definitive diagnosis when MRA is negative but clinical suspicion remains high based on positive FABER and restricted hip quadrant 4, 2

Common Pitfalls to Avoid

• Do not dismiss hip pathology based on normal plain radiographs alone—all patients in one arthroscopy series had normal X-rays but confirmed intra-articular pathology 2
• Do not rely on FABER test alone—combine with other provocative maneuvers and ROM assessment for accurate diagnosis 5
• Do not assume negative MRA excludes pathology—proceed to arthroscopy if clinical findings strongly suggest intra-articular disease 2
• Consider referred pain patterns—hip pathology commonly presents as groin pain, but also buttock and low back pain 2

Associated Findings That Increase Diagnostic Certainty

• Mechanical symptoms: Clicking, locking, or giving way suggest labral pathology 4
• Positive Arlington test (sensitivity 94%) or twist test (specificity 72%) further support labral tear diagnosis 6
• Altered gait mechanics: Slower squat velocity, slower sit-to-stand, increased hip flexion moments during walking 5

If You Actually Mean Shoulder Tests (Hawkins-Kennedy Test)

The Hawkins-Kennedy test assesses for subacromial impingement and rotator cuff pathology in the shoulder. A positive test (pain with forward flexion to 90° and internal rotation) suggests supraspinatus tendinopathy or subacromial bursitis. However, this was not addressed in the provided evidence, which focuses on hip and lower extremity pathology.