Femoroacetabular Impingement

Procedure

Patient supine with hip flexed and slightly abducted. Examiner applies gentle axial loading to femur while internally and externally rotating the hip through range. Positive if pain localizes to groin.

Positive Finding

Anterior hip, groin, or medial hip pain with axial loading and rotation, particularly during internal rotation phase

Sensitivity / Specificity

Reference: Maslowski E, Sullivan W, Forster Harwood J, Gonzalez P, Kaufman M, Vidal A, Akuthota V. The diagnostic validity of hip provocation maneuvers to detect intra-articular hip pathology. PM R 2010;2(3):174-81; PMID 20359681

Interpretation

Pain on scouring suggests an intra-articular source, but the test is weak both ways — 50-62% sensitive, 29-38% specific — so a negative does not exclude and most positives are false alarms. Use it alongside FADIR, FABER, internal rotation range and imaging. Scour with adduction is also one of the five Sutlive hip osteoarthritis predictors, valuable only in combination with the other four.

Procedure

Patient supine; examiner flexes, abducts, and externally rotates the hip, then applies gentle overpressure.

Positive Finding

Anterior groin or hip pain at end-range of flexion, abduction, and external rotation

Interpretation

Sensitive but not specific: a positive FABER means the hip joint is a plausible source, not that femoroacetabular impingement is the cause — it cannot separate impingement from labral pathology, capsular irritation or early osteoarthritis. Groin or anterior hip pain is the meaningful response; lateral pain suggests an extra-articular source. Combine with the anterior impingement test, restricted internal rotation in flexion, and imaging. In one study of 50 people referred for a hip joint injection (Maslowski 2010), FABER was positive in 82% of those whose pain came from inside the joint (at least 80% relief after the injection). No test in that study correctly cleared more than about a third of the people whose pain was not from the joint, so a positive FABER cannot confirm the joint as the source, let alone which structure is at fault. The study looked at pain from inside the hip joint in general, not this condition specifically, so no figure is shown.

Procedure

Patient supine with hip and knee flexed to 90°. Examiner applies passive external rotation and abduction. Positive if patient reports apprehension of instability or pain.

Positive Finding

Apprehension or sense of instability in anterior hip region; may be accompanied by pain

Interpretation

Apprehension or a sense of instability in extension with external rotation raises the possibility of anterior hip microinstability or capsular laxity, which can coexist with femoroacetabular impingement and can change management. No validated diagnostic-accuracy figures support this test, so treat a positive result as a prompt to assess for generalised laxity and consider imaging, not as evidence of instability.

Procedure

Patient supine with hip and knee slightly flexed (~20°). Examiner gently internally and externally rotates hip through available range. Positive if groin pain occurs.

Positive Finding

Anterior hip or groin pain with passive internal rotation, or apprehension with external rotation

Interpretation

The log roll moves the femoral head within the acetabulum with the surrounding musculature relaxed, so a painful or restricted result points to the joint and capsule rather than to muscle or tendon. That relative specificity for an intra-articular source is its only real strength. It is NOT a screening test — sensitivity is low, so a normal log roll does not exclude femoroacetabular impingement. Use FADIR to screen.

Procedure

Patient supine; hip flexed to 90°, adducted, and internally rotated. Apply gentle overpressure. Positive if anterior hip or groin pain occurs.

Positive Finding

Anterior hip or groin pain with passive hip flexion, adduction, and internal rotation

Sensitivity / Specificity

Reference: Reiman MP, Goode AP, Cook CE, Hölmich P, Thorborg K. Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: a systematic review with meta-analysis. Br J Sports Med 2015;49(12):811; PMID 25515771

Interpretation

The best available screening test for intra-articular hip pathology, and a poor confirmatory one. Pooled sensitivity 0.94-0.99, so a negative FADIR makes femoroacetabular impingement or labral pathology unlikely — that is the informative result. A positive is weak on its own: specificity is low, and the test is frequently positive in asymptomatic hips, osteoarthritis and labral tears. Pair with FABER, restricted internal rotation in flexion, and imaging.