FADIR Test

The FADIR test (Flexion–Adduction–Internal Rotation) is a commonly used orthopedic test designed to identify hip pathologies, particularly:

• Femoroacetabular impingement (FAI)

• Labral tears (anterior labrum)

• Iliopsoas tendinitis [3]

The test functions primarily as an exclusion tool, with high sensitivity, making it particularly valuable for ruling out FAI when the result is negative [1].

Physiotutors.com

Patient Position

• The patient lies in a supine position on the examination table.

• 
  

Step-by-Step Execution

1. Flexion – The hip is flexed to 90° (or maximal comfortable flexion).

2. Adduction – The hip is moved medially toward the midline.

3. Internal Rotation – The hip is rotated inward while maintained in flexion and adduction.

4. Observation – The test is considered positive if:

   • Pain occurs in the groin area.

   • Symptoms are reproduced, with or without a clicking sensation [4].

Interpretation of Results

• Positive Test: Groin pain or symptom reproduction, which may indicate:

  • Labral tear (degeneration, fraying, or rupture).

  • Femoroacetabular impingement (anterior impingement).

  • Iliopsoas tendinitis [5].

• Negative Test: Strongly suggests that FAI is unlikely.

Diagnostic Validity and Evidence

Sensitivity and Specificity

Diagnostic Context	Sensitivity	Specificity
FADIR (general use)	0.96	0.11
FADIR (X-ray confirmed FAI)	0.08–1.00	0.11
FADIR (MRI confirmed FAI)	0.33–1.00	1.00
FADIR (CT confirmed FAI)	0.90	–

• High sensitivity (0.96): A negative test effectively rules out FAI [8].

• Low specificity (0.11): A positive test alone is insufficient for diagnosis [7].

Comparison with Other Tests

• FADIR combined with Foot Progression Angle Walking (FPAW) and maximal squat test yields the highest diagnostic accuracy for FAI.

• Additional recommended tests:

  • Anterior impingement test

  • Passive hip rotation in neutral position [1]

Clinical Relevance

The FADIR test is widely used in the clinical evaluation of hip pathology, particularly FAI and labral lesions.

However, due to its high sensitivity and low specificity, it should not be used in isolation. Instead, it must be interpreted alongside other clinical tests and imaging modalities (such as MRI or CT) to achieve diagnostic accuracy [1].

Limitations

• A positive FADIR test alone is not diagnostic.

• The test can also be positive in:

  • Hip osteoarthritis

  • Bursitis

  • Iliopsoas-related pathologies

• Must always be used in combination with other examinations for differential diagnosis.

Conclusion

The FADIR test is a highly sensitive clinical tool, best suited to rule out FAI when negative. A positive result suggests hip pathology but requires additional tests and imaging for confirmation. Used in combination with other clinical assessments, the FADIR test remains an essential part of modern hip evaluation.

Sources:

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. ‌

2. 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. 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 

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.