Hip Labral Tear

Procedure

Patient supine. Hip flexed 90° and adducted across the body. Examiner applies axial compression through the knee while circumducting the hip through full range. Pain during movement is noted.

Positive Finding

Pain reproduction (especially in flexion, adduction, and internal rotation quadrant) without radiation into the limb; clicking or catching sensation

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

Axial compression combined with circumduction loads the articular surface and labrum, so pain suggests an intra-articular source — but the test is weak in both directions: 50-62% sensitive, 29-38% specific. A negative result does not exclude a labral tear, and a positive is more often than not a false alarm. Use the scour as one contributor alongside FADIR, the anterior labral test and imaging.

Procedure

Patient supine. This is a dynamic maneuver, not a static position. Begin with the hip in full flexion, external rotation and abduction. From there, move the hip into extension while simultaneously internally rotating and adducting. Perform the arc smoothly and watch the patient's face; ask them to report the moment pain appears rather than only at the end.

Positive Finding

Reproduction of the patient's deep anterior hip or groin pain during the arc, with or without an audible or palpable click. A click alone, without concordant pain, is not a positive test — clicking hips are common and often asymptomatic.

Interpretation

Concordant groin pain through this arc is consistent with anterosuperior labral pathology, where the majority of tears occur. It cannot distinguish a labral tear from femoroacetabular impingement, and the two frequently coexist — cam or pincer morphology is a common cause of the tear. Diagnosis rests on MR arthrography or response to intra-articular anaesthetic; this test decides whether that workup is warranted.

Procedure

Patient supine. Hip and knee flexed, foot placed on opposite knee, gentle downward pressure applied to the flexed hip into abduction. Observe pain location and range.

Positive Finding

Groin or anterior hip pain (not lateral hip); may indicate intra-articular pathology if pain is deep or clicking occurs

Interpretation

FABER screens broadly for intra-articular hip pathology — labral tear, impingement, early osteoarthritis — and does not identify the labrum specifically. Deep groin or anterior hip pain supports an intra-articular source; lateral pain suggests greater trochanteric or other extra-articular pathology; posterior pain should raise the sacroiliac joint. It is sensitive but not specific, so a negative test is more informative than a positive one. 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, close to the edge of the table so the hip can be extended. Begin with the hip in extension, abduction and external rotation. From there, move into further extension with internal rotation and adduction. As with the anterior test this is a dynamic arc, performed smoothly, with the patient reporting when pain appears.

Positive Finding

Reproduction of the patient's deep posterior hip or buttock pain during the arc, with or without a click. Restriction of movement alone, or a click without concordant pain, is not a positive test.

Interpretation

Concordant posterior pain through this arc is consistent with posteroinferior labral pathology, which is considerably less common than anterosuperior tears. Posterior hip and buttock pain has a wide differential — sacroiliac joint, deep gluteal syndrome, proximal hamstring tendinopathy, lumbar referral — so a positive result should be interpreted alongside the rest of the examination rather than taken as evidence of a labral tear.

Procedure

Patient supine. Hip flexed to 110–120°, adducted, and internally rotated. Examiner applies gentle overpressure. Note pain reproduction.

Positive Finding

Anterior groin pain or deep intra-articular pain with end-range positioning

Interpretation

Anterior groin pain reproduced in deep flexion with adduction and internal rotation is consistent with anterosuperior labral involvement or femoroacetabular impingement, and the deeper flexion angle can provoke symptoms that are missed at 90 degrees. Like every hip provocation maneuver it is sensitive rather than specific: a positive result means the joint is worth investigating, not which structure is at fault. This is the FADIR manoeuvre taken into deeper flexion. A 2015 meta-analysis of tests for impingement and labral tears (Reiman et al., BJSM) found pooled sensitivity for FADIR of 94–99% and judged it useful for screening only, not for confirming a tear. No study of the deeper-flexion version on its own was found, so no figure is shown.

Procedure

Perform FABER test (as above) and immediately follow with FADIR: hip flexed 90°, adducted and internally rotated with downward pressure. Compare pain location and pattern between positions.

Positive Finding

Intra-articular (groin/anterior hip) pain in either or both positions; concordant pain reproduction with mechanical pattern suggests labral involvement

Interpretation

Perform both, but for what each contributes rather than for any combined accuracy figure. FADIR is the sensitive one (pooled 0.94-0.99): a negative FADIR makes intra-articular pathology unlikely and is the most useful negative finding at the hip. FABER adds information about where the pain is felt, separating intra-articular from lateral and posterior sources. Neither becomes specific by being combined, and concordant groin pain in both positions still cannot distinguish a labral tear from impingement or early osteoarthritis.