How to Perform the FADIR Test
The FADIR (Flexion-Adduction-Internal Rotation) test is performed with the patient supine: flex the hip to 90°, then passively adduct and internally rotate the hip while observing for pain reproduction. 1, 2
Patient Positioning
- Position the patient supine on the examination table with legs initially straight and parallel, toes pointing upward 3
- Ensure the pelvis is level and not rotated, as pelvic obliquity can create false impressions 3
- Align the limbs and trunk to the body's midline to establish a neutral reference position 3
Test Execution Steps
- Step 1: Flex the hip to 90° while keeping the knee flexed to 90° 4, 5
- Step 2: Passively adduct the hip (bring the knee toward the opposite shoulder) 5
- Step 3: Internally rotate the hip while maintaining flexion and adduction 1, 4
- Step 4: Observe for reproduction of the patient's hip pain during this combined motion 1, 6
Test Interpretation
Positive Test
- Pain reproduction during the maneuver suggests possible intra-articular hip pathology, but a positive FADIR test is not specific to any single condition and may indicate FAI syndrome, labral tear, acetabular dysplasia, hip instability, or other intra-articular pathology 7
- The test demonstrates high sensitivity (ranging from 0.80 to 1.0) but low specificity (0.11 to 0.26), making it poor for confirming disease when positive 8, 6
Negative Test
- A negative FADIR test helps rule out hip disease in young and middle-aged active adults with hip-related pain 1, 2, 7
- The test's greatest clinical utility is ruling out hip pathology when negative rather than confirming it when positive 2, 7
Reliability Considerations
- The FADIR test shows substantial inter-rater agreement with kappa values above 0.6 between experienced raters 6
- Intrarater reliability is moderate (0.75) while interrater reliability is poor to moderate (0.40), with minimal detectable difference ranging from 12.8° to 28.6° 4
- The test should be standardized due to variability in measurement reliability 4
Clinical Pitfalls to Avoid
- Never diagnose based on the FADIR test alone—imaging findings must always be combined with patient symptoms and clinical signs 1, 2, 7
- Patients may compensate with pelvic tilting, creating false positioning, so stabilize the pelvis during assessment 3
- Before attributing symptoms to FAI or labral pathology, exclude tumors, infections, stress fractures, slipped capital femoral epiphysis, and competing conditions such as lumbar spine pathology 7
- Labral tears and chondral lesions are frequently present on imaging in asymptomatic individuals, so finding these does not confirm they are the pain source 7