FADER Test
Top Contributors - Trista Chan, Carina Therese Magtibay and Saud Alghamdi
Description
FADER test stands for Flexion, Adduction, External Rotation test. This is a pain provacation test of the hip for assessing gluteal tendinopathy.
Clinically Relevant Anatomy
Gluteus medius[1]: It originates from the gluteal fossa, the gluteal aponeurosis and the postero-inferior iliac crest, and inserts onto the lateral aspect of the greater trochanter. It is responsible for abduction and internal rotation of the hip. It also acts as a stabiliser of the pelvis.
Gluteus minimus[1]: It originates from the ilium between the anterior and inferior gluteal lines, and inserts onto the anterior aspect of the greater trochanter. It assists in hip abduction and internal rotation and stabilises the pelvis with gluteus medius.
More detailed information of the hip anatomy can be found here.
Purpose
The FADER test aims to provoke symptoms in a position that increases tensile and compressive stress of the tendons of the gluteal muscles, i.e., the gluteus medius and gluteus minimus[2]. The FADER-R test is performed to further increase tensile and compressive load by adding in the component of active internal rotation[2]. A positive test result suggests gluteal tendinopathy may be indicated.[2]
Technique[2]
FADER:
- Patient lies in supine.
- Bring the hip into passive flexion to 90°.
- Then passively adduct and externally rotated the hip to end range.
Interpretation: Pain reproduction indicates a positive test result. The test can be continued on by adding resisted isometric internal rotation. This is called the FADER-R test.
FADER-R:
- Patient lies supine in the FADER's position.
- Patient isometrically resist against internal rotation.
Interpretation:Pain reproduction indicates a positive test result.
Evidence
The FADER test has a sensitivity of 0.3 and specificity of 0.867[2]. The FADER-R test has a higher sensitivity of 0.44 and specificity of 0.933, suggesting that active resistance effectively increases tensile and compressive load, which increases validity of the test[2].
Clinical Relevance
Due to the low sensitivity and high speificity of the FADER test, a positive test can help us improve our confidence that gluteal tendinopathy is present. However, a a negative test does not completely exclude the condition[2]. Therefore, it is essential to use a combination of assessment tools such as patient history, physical exam (e.g., palpation, FABER test, Ober's test, single leg stance etc) and imaging to improve our confidence when diagnosing conditions such as gluteal tendinopathy
References
- ↑ 1.0 1.1 Sunil Kumar, Karadi Hari, et al. “Pathogenesis and Contemporary Diagnoses for Lateral Hip Pain: A Scoping Review.” Knee Surgery, Sports Traumatology, Arthroscopy, vol. 29, no. 8, 19 Dec. 2020, pp. 2408–2416, https://doi.org/10.1007/s00167-020-06354-1.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Grimaldi, Alison, et al. “Utility of Clinical Tests to Diagnose MRI-Confirmed Gluteal Tendinopathy in Patients Presenting with Lateral Hip Pain.” British Journal of Sports Medicine, vol. 51, no. 6, 15 Sept. 2016, pp. 519–524, https://doi.org/10.1136/bjsports-2016-096175.