FADIR (Flexion, Adduction, Internal Rotation) Test: Difference between revisions
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== Clinically Relevant Antomoy == | == Clinically Relevant Antomoy == | ||
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 | 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<ref name=":1">Drake, R.L., Vogl, W. and Mitchell, A.W.M. (2019). ''Gray’s anatomy for students''. 4th ed. Philadelphia: Elsevier. | ||
</ref>. | </ref>. | ||
The hip joint is surrounded by a fibrocartilaginous structure called the labrum, which raises the acetabular rim to provide stability<ref name=":1" />. | The hip joint is surrounded by a fibrocartilaginous structure called the labrum, which raises the acetabular rim to provide stability<ref name=":1" />. | ||
More detailed information of the hip anatomy can be found [[Hip|here]]. | |||
== Technique == | == Technique == | ||
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'''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.<ref name=":0" /> | '''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.<ref name=":0" /> | ||
'''Interpretation:''' Pain in the groin area is considered indicative of labral pathology, including degeneration, fraying, or tearing<ref name=":0" />. This is also known as a positive impingement sign<ref>Fortier, L.M., Popovsky, D., Durci, M.M., Norwood, H., Sherman, W.F. and Kaye, A.D. (2022). [https:// | '''Interpretation:''' Pain in the groin area is considered indicative of labral pathology, including degeneration, fraying, or tearing<ref name=":0" />. This is also known as a positive impingement sign<ref>Fortier, L.M., Popovsky, D., Durci, M.M., Norwood, H., Sherman, W.F. and Kaye, A.D. (2022). [https://orthopedicreviews.openmedicalpublishing.org/article/37513-an-updated-review-of-femoroacetabular-impingement-syndrome An Updated Review of Femoroacetabular Impingement Syndrome]. ''Orthopedic Reviews'', [online] 14(3). doi:<nowiki>https://doi.org/10.52965/001c.37513</nowiki>. | ||
</ref>. | </ref>. | ||
{{#ev:youtube|osQMAWOYTuo|300}} <ref>Vince Isaac. FADDIR Test. Available from: https://youtu.be/osQMAWOYTuo [last accessed 24/10/2022]</ref> | {{#ev:youtube|osQMAWOYTuo|300}} <ref>Vince Isaac. FADDIR Test. Available from: https://youtu.be/osQMAWOYTuo [last accessed 24/10/2022]</ref> | ||
== Evidence == | == Evidence == | ||
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Another systematic review found the FADIR test to have high sensetivity 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.<ref>Caliesch R, Sattelmayer M, Reichenbach S, Zwahlen M, Hilfiker R. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7213881/ 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.</ref> | Another systematic review found the FADIR test to have high sensetivity 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.<ref>Caliesch R, Sattelmayer M, Reichenbach S, Zwahlen M, Hilfiker R. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7213881/ 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.</ref> | ||
== 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<ref name=":2">Pålsson, A., Kostogiannis, I. and Ageberg, E. (2020). [https://pubmed.ncbi.nlm.nih.gov/32335699/ 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:<nowiki>https://doi.org/10.1007/s00167-020-06005-5</nowiki>. | |||
</ref>. In clinical practice, the FADIR test can effectively rule out femoroacetabular impingement, but a combination of tests is needed to rule in the condition<ref name=":2" />. | |||
== References == | == References == | ||
Revision as of 06:46, 1 July 2023
This article is currently under review and may not be up to date. Please come back soon to see the finished work! (1/07/2023)
Purpose[edit | edit source]
The FADIR (flexion, adduction, internal rotation) test is used for the examination of femoroacetabular impingement syndrome, anterior labral tear and iliopsoas tendinitis.[1]
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.[2]
This test is also called Anterior apprehension test.
Clinically Relevant Antomoy[edit | edit source]
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.
Technique[edit | edit source]
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.[2]
Interpretation: Pain in the groin area is considered indicative of labral pathology, including degeneration, fraying, or tearing[2]. This is also known as a positive impingement sign[4].
Evidence[edit | edit source]
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.[6]
Another systematic review found the FADIR test to have high sensetivity 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.[7]
Clinical Relevance[edit | edit source]
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[8]. In clinical practice, the FADIR test can effectively rule out femoroacetabular impingement, but a combination of tests is needed to rule in the condition[8].
References[edit | edit source]
- ↑ David J. Magee. Orthopedic Physical Assessment. 6th edition. Elsevier. 2014.
- ↑ 2.0 2.1 2.2 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
- ↑ 3.0 3.1 Drake, R.L., Vogl, W. and Mitchell, A.W.M. (2019). Gray’s anatomy for students. 4th ed. Philadelphia: Elsevier.
- ↑ 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.
- ↑ Vince Isaac. FADDIR Test. Available from: https://youtu.be/osQMAWOYTuo [last accessed 24/10/2022]
- ↑ 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.
- ↑ 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.
- ↑ 8.0 8.1 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.
