Jump to content

FADIR (Flexion, Adduction, Internal Rotation) Test

Original Editor - Anas Mohamed Top Contributors - Anas Mohamed, Trista Chan, Lilian Ashraf, Ishita Pareek and Kim Jackson

Description

The FADIR test stands for Flexion, Adductionand Internal Rotation test. This is an exclusion tool for several hip pathologies[1].

The FADIR test (Flexion, Adduction, Internal Rotation test) is a clinical examination maneuver used to assess for hip pathology, particularly to diagnose hip impingement, labral tears, or femoroacetabular impingement (FAI). It is commonly performed in individuals who present with hip pain or groin discomfort, especially when there is suspicion of structural abnormalities in the hip joint.[2]

Purpose of the FADIR Test:

The FADIR test is primarily used to reproduce symptoms associated with hip impingement, labral tears, and other hip joint dysfunctions. It can help diagnose conditions like:

  • Femoroacetabular Impingement (FAI): A condition where there is abnormal contact between the femoral head and the acetabulum, often leading to hip pain.
  • Labral Tears: Injury or tears to the acetabular labrum, which is a cartilage structure that helps stabilize the hip joint.
  • Hip Osteoarthritis: Degeneration of the hip joint's cartilage.[2]

Clinically Relevant Antomy

The hip joint is a multiaxial ball-and-socket joint formed by the femoral head and the acetabulum of the pelvis. It is involved in flexion, extension, abduction, adduction, internal and external rotation, and circumduction of the hip[3].

The hip joint is surrounded by a fibrocartilaginous structure called the labrum, which raises the acetabular rim to provide stability[3].

More detailed information of the hip anatomy can be found here.

Purpose

The FADIR (flexion, adduction, internal rotation) test is used for the examination of femoroacetabular impingement syndrome, anterior labral tear and iliopsoas tendinitis.[4]

The premise of this test is that flexion and adduction motions approximates the femoral head with the acetabular rim. Then internally rotating the hip places a shearing force on the labrum.[5]

Technique

Step 1. Patient is in supine position.

Step 2. Affected hip fully flexed or 90 degree flexion.

Step 3. Adduct the hip with combined Internally rotation of the hip.

Step 4. A positive test is indicated by the production of pain in the groin, the reproduction of the patient’s symptoms with or without a click, or apprehension.[5]

Interpretation: Pain in the groin area is considered indicative of labral pathology, including degeneration, fraying, or tearing[5]. This is also known as a positive impingement sign[6].

[7]

Evidence

For diagnosing Femoroacetabular Impingement (FAI). The sensitivity when confirmed by x-ray, MRI, or CT was 0.08 to 1, 0.33 to 1 and 0.90, respectively. The specificity when confirmed by x-ray and MRI was 0.11 and 1, respectively.[8]

Another systematic review found the FADIR test to have high sensitivity of 0.96 and low specificity of 0.11. The FADIR test along with the Foot Progression Angle Walking (FPAW) test and the maximal squat test were found to have the best sensetivities for FAI.[9]

Clinical Relevance

The FADIR test is commonly used in the assessment of hip pathology, espeially femoroacetabular impingement and labral tear. However, due to high sensitivity and low specificity of the test, it is important to understand its limitations and consider its role in conjunction with other tests and diagnostic tools when assessing hip pathology[1].

In clinical practice, a negative FADIR test can effectively rule out femoroacetabular impingement, but a combination of tests, such as anterior impingement test and passive hip ROM in internal rotation with hip in neutral, is needed for dignostic purposes[1].

References

  1. ↑ 1.0 1.1 1.2 Pålsson, A., Kostogiannis, I. and Ageberg, E. (2020). Combining results from hip impingement and range of motion tests can increase diagnostic accuracy in patients with FAI syndrome. Knee Surgery, Sports Traumatology, Arthroscopy, 28(10), pp.3382–3392. doi:https://doi.org/10.1007/s00167-020-06005-5. ‌
  2. ↑ 2.0 2.1 Shanmugaraj A, Shell JR, Horner NS, Duong A, Simunovic N, Uchida S, Ayeni OR. How Useful Is the Flexion-Adduction-Internal Rotation Test for Diagnosing Femoroacetabular Impingement: A Systematic Review. Clin J Sport Med. 2020 Jan;30(1):76-82. doi: 10.1097/JSM.0000000000000575. PMID: 31855915.[1]
  3. ↑ 3.0 3.1 Drake, R.L., Vogl, W. and Mitchell, A.W.M. (2019). Gray’s anatomy for students. 4th ed. Philadelphia: Elsevier. ‌
  4. ↑ David J. Magee. Orthopedic Physical Assessment. 6th edition. Elsevier. 2014.
  5. ↑ 5.0 5.1 5.2 Leibold MR, Huijbregts PA, Jensen R. Concurrent criterion-related validity of physical examination tests for hip labral lesions: a systematic review. J Man Manip Ther. 2008;16(2):E24-E41. doi:10.1179/jmt.2008.16.2.24E
  6. ↑ Fortier, L.M., Popovsky, D., Durci, M.M., Norwood, H., Sherman, W.F. and Kaye, A.D. (2022). An Updated Review of Femoroacetabular Impingement Syndrome. Orthopedic Reviews, [online] 14(3). doi:https://doi.org/10.52965/001c.37513. ‌
  7. ↑ Vince Isaac. FADDIR Test. Available from: https://youtu.be/osQMAWOYTuo [last accessed 24/10/2022]
  8. ↑ Shanmugaraj A, Shell JR, Horner NS, Duong A, Simunovic N, Uchida S, Ayeni OR. How useful is the flexion–adduction–internal rotation test for diagnosing femoroacetabular impingement: a systematic review. Clinical Journal of Sport Medicine. 2020 Jan 1;30(1):76-82.
  9. ↑ Caliesch R, Sattelmayer M, Reichenbach S, Zwahlen M, Hilfiker R. Diagnostic accuracy of clinical tests for cam or pincer morphology in individuals with suspected FAI syndrome: a systematic review. BMJ open sport & exercise medicine. 2020 Apr 1;6(1):e000772.
Retrieved from "https://www.physio-pedia.com/w/index.php?title=FADIR_(Flexion,_Adduction,_Internal_Rotation)_Test&oldid=367455"