From the Guidelines
A negative FADIR test can help rule out hip disease in young and middle-aged active adults presenting with posterior hip pain, as recommended by the international hip-related pain research network 1. When performing the FADIR test on a patient with posterior hip pain, it is essential to consider the test's diagnostic accuracy and its role in the overall clinical assessment. The FADIR test is a valuable tool in helping to identify hip pathology, including femoroacetabular impingement (FAI), acetabular labral tears, or posterior hip capsule pathology.
Key Considerations
- A positive FADIR test may indicate intra-articular hip pathology, and further evaluation, including imaging studies and referral to an orthopedic specialist, may be necessary 1.
- Initial management of posterior hip pain during the FADIR test typically includes activity modification, non-steroidal anti-inflammatory drugs (NSAIDs), and physical therapy focusing on hip mobility and core strengthening.
- The FADIR test places stress on the anterior hip structures, causing the femoral head to engage the acetabulum, which can reproduce symptoms in patients with intra-articular hip pathology.
Diagnostic Approach
- The diagnostic utility of imaging for hip disease in people with hip-related pain is limited, and imaging should always be combined with the patient's symptoms and clinical signs 1.
- AP pelvis and lateral femoral head–neck radiographs are recommended to assist in the diagnoses of hip conditions associated with hip-related pain, while MRI/MRA or CT scan may be indicated for three-dimensional morphological assessment or to evaluate intra-articular structures 1.
From the Research
FADIR Test with Posterior Hip Pain
- The FADIR test is used to diagnose femoroacetabular impingement (FAI), but its diagnostic utility remains unclear 2.
- Posterior hip pain is associated with various conditions, including piriformis syndrome, sacroiliac joint dysfunction, and lumbar radiculopathy 3.
- The FADIR test may be a useful screening tool for FAI due to its low risk, but its sensitivity and specificity values vary widely 2, 4.
- Clinical examination tests, including the FADIR test, are not highly sensitive or specific for most diagnoses, and a rational approach to the hip examination is recommended 3.
- Imaging examinations, such as X-ray, MRI, and CT, may be used to confirm the diagnosis of FAI, but their accuracy can vary depending on the reference standard used 2, 4.
Diagnostic Accuracy of FADIR Test
- The sensitivity of the FADIR test ranges from 0.08 to 1, and its specificity ranges from 0.11 to 1, depending on the reference standard used 2.
- The FADIR test may be more useful as a screening tool for FAI rather than a definitive diagnostic test 4.
- Further research is needed to validate the use of the FADIR test and other clinical tests for diagnosing FAI 4.
Posterior Hip Pain and FADIR Test
- Posterior hip pain is not typically associated with FAI, but it can be a symptom of other conditions that may be diagnosed using the FADIR test 3.
- The FADIR test may not be as useful for diagnosing conditions that cause posterior hip pain, such as piriformis syndrome or sacroiliac joint dysfunction 3.