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FABER Test

Original Editor - Tyler Shultz

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Purpose

The FABER (Patrick’s) Test stands for: Flexion, Abduction and External Rotation, is a clinical pain provocation test designed to assist in diagnosising of pathologies in the hip, lumbar spine, and sacroiliac. [1] It is a passive screening tool used to reproduce pain and identify musculoskeletal dysfunctions, such as hip, lumbar spine, or sacroiliac joint dysfunction, or an iliopsoas spasm.[2][1]

The test assesses the hip by transferring forces through the joint. When the position of flexion, abduction, and external rotation, is combined with overpressure, it stresses the femoral-acetabular joint and may produce pain if irritation or pathology is present.[3][4]Additionally, horizontal abduction force are transferred through the femur to the sacroiliac joint via tension in the soft tissues, making the test valuable for identifying sacroiliac joint dysfunction.

The FABER test can guide practitioners on whether further imaging or additional assessments, such as range of movement or hip quadrant tests, are needed in patients with persistent hip or groin pain.[5]

The evidence supporting this test is varied and more studies are required to fully assess the value of this and other hip pathology tests[6]. Although more evidence is becoming apparent that physical tests are less reliable and subject to user error. [7]

For more detailed information on the anatomy of the hip, lumbar spine and Sacroiliac Joint.

Technique

The patient is positioned in supine. The leg is placed in a figure-4 position (hip flexed and abducted with the lateral ankle resting on the contralateral thigh proximal to the knee, knee flexed to 90 degrees[8] While stabilizing the opposite side of the pelvis at the anterior superior iliac spine, an external rotation, abduction and posterior force is then lightly applied to the ipsilateral knee until the end range of motion is achieved. A further few small-amplitude oscillations can be applied to check for pain provocation at the end range of motion. [9] A positive test is one that reproduces the patient's pain or limits their range of movement. [8]

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[10]

Interpretation

The following findings of a positive FABER test may help to guide your clinical diagnosis;

  1. Sarcoiliac Joint Pain on external hip rotation
  2. Groin Pain on external hip rotation
  3. Posterior Hip Pain on external hip rotation
    • Posterior Hip Impingement

Evidence

  • Reliability: FABER measured with a ruler, normalized FABER range of movement, and inclinometry all resulted in excellent intra-rater reliability, with the highest ICC being demonstrated for inclinometry (ICC 0.86, 0.86, and 0.91).[13] The use of an inclinometer may increase reliability when performed by an experienced clinician in comparison with height measutements.
  • Sensitivity for identification of hip pathology identified with arthroscopy: 0.89[5]
  • Correlation of positive test with OA on radiographs: r = 0.54[12]
  • Kappa (95% Confidence interval): 0.63 (0.43-0.83), Kappa Maximum: 0.83, Percent agreement: 84%, Prevalence: 0.37, Bias: 0.07[1]
  • Diagnostic value of FABER test compared to MR arthrogra¬phy in labral tear diagnostics: sensitivety: 41%, specificity: 100%, positive predictive value: 100%, negative predictive value: 9%[9]
  • The validity and reliability of the FABER test is very contradictory, some say it is an invalid and unreliable test[14] , while others disagree about the outcome and feel physical diagnostic tests do not have enough quality evidence to support the use of them for diagnosis purposes.[7] [15]

References

  1. ↑ 1.0 1.1 1.2 Martin RL, Sekiya JK. The interrater reliability of 4 clinical tests used to assess individuals with musculoskeletal hip pain. J Orthop Sports Phys Ther. 2008 Feb;38(2):71-7. Epub 2007 Sep 21.
  2. ↑ Dutton M. Orthopaedic: Examination, evaluation, and intervention. 2nd ed. New York: The McGraw-Hill Companies, Inc; 2008.
  3. ↑ Broadhurst NA, Bond MJ. Pain provocation tests for the assessment of sacroiliac joint dysfunction. Journal of Spinal Disorders. 1998 Aug;11(4):341-5.
  4. ↑ Philippon MJ, Stubbs AJ, Schenker ML, Maxwell RB, Ganz R, Leunig M. Arthroscopic management of femoroacetabular impingement: osteoplasty technique and literature review. The American journal of sports medicine. 2007 Sep;35(9):1571-80.
  5. ↑ 5.0 5.1 B, McCroy P, Brukner P, et al. Hip joint pathology: Clinical presentation and correlation between magnetic resonance arthrography, ultrasound, and arthroscopic findings in 25 consecutive cases. Clin J Sports Med. 2003;(13):152-156
  6. ↑ Reiman MP, Goode AP, Hegedus EJ, Cook CE, Wright AA. Diagnostic accuracy of clinical tests of the hip: a systematic review with meta-analysis. Br J Sports Med. 2013 Sep 1;47(14):893-902.
  7. ↑ 7.0 7.1 Tijssen M, van Cingel R, Willemsen L, de Visser E. Diagnostics of femoroacetabular impingement and labral pathology of the hip: a systematic review of the accuracy and validity of physical tests. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2012 Jun 1;28(6):860-71.
  8. ↑ 8.0 8.1 Flynn T, Cleland J, Whitman J. User's guide to the musculoskeletal examination: Fundamentals for the evidence-based clinician. Buckner, Kentucky: Evidence in Motion; 2008
  9. ↑ 9.0 9.1 9.2 Troelsen A, Mechlenburg I, Gelineck J, Bolvig L, Jacobsen S, Søballe K. What is the role of clinical tests and ultrasound in acetabular labral tear diagnostics? Acta Orthop. 2009 Jun;80(3):314-8.
  10. ↑ Faber Test | Patrick Faber's Test for Hip Pain Available from:https://www.youtube.com/watch?v=nFza4MJv2Uo
  11. ↑ Bagwell JJ, Bauer L, Gradoz M, Grindstaff TL. The reliability of FABER test hip range of motion measurements. International journal of sports physical therapy. 2016 Dec;11(7):1101. [1]
  12. ↑ 12.0 12.1 Theiler R, Stucki G, Schotz R, Hofer H, Seifert B. Parametric and non-parametric measures in the assessment of knee and hip osteoarthritis: interobserver reliability and correlation with radiology. Osteoarthritis Cartilage. 1996:35-42.
  13. ↑ Bagwell JJ, Bauer L, Gradoz M, Grindstaff TL. The reliability of FABER test hip range of motion measurements. International journal of sports physical therapy. 2016 Dec;11(7):1101.
  14. ↑ Cattley P, Winyard J, Trevaskis J, Eaton S. Validity and reliability of clinical tests for the sacroiliac joint. A review of literature. Australas Chiropr Osteopathy. 2002 Nov;10(2):73-80.
  15. ↑ Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B.European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J. 2008 Jun;17(6):794-819. Epub 2008 Feb 8.


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