FADIR (Flexion, Adduction, Internal Rotation) Test

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

Description[edit | edit source]

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

Clinically Relevant Antomy[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[2].

The hip joint is surrounded by a fibrocartilaginous structure called the labrum, which raises the acetabular rim to provide stability[2].

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

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.[3]

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.[4]

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.[4]

Interpretation: Pain in the groin area is considered indicative of labral pathology, including degeneration, fraying, or tearing[4]. This is also known as a positive impingement sign[5].


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.[7]

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.[8]

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[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[edit | edit source]

  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 Drake, R.L., Vogl, W. and Mitchell, A.W.M. (2019). Gray’s anatomy for students. 4th ed. Philadelphia: Elsevier. ‌
  3. David J. Magee. Orthopedic Physical Assessment. 6th edition. Elsevier. 2014.
  4. 4.0 4.1 4.2 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
  5. 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. ‌
  6. Vince Isaac. FADDIR Test. Available from: https://youtu.be/osQMAWOYTuo [last accessed 24/10/2022]
  7. 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.
  8. 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.