Which finding is the most sensitive for femoroacetabular impingement on physical examination?

Which finding is the most sensitive for femoroacetabular impingement on physical examination?

• A. Reproduction of pain with the FADIR test
• B. Pain with resisted hip abduction
• C. Positive FABER test
• D. Limited external rotation with the hip flexed

Answer: (A)

The key idea is which exam maneuver most reliably picks up femoroacetabular impingement (FAI) across patients — its presence is defined by pain reproduced during the test. Reproducing pain with the FADIR maneuver (flexion, adduction, internal rotation) is most sensitive for detecting FAI. This position narrows the space between the femoral head-neck junction and the acetabular rim, so if there is impingement, the abnormal contact commonly provokes intra-articular pain early in the range. Because this sign tends to occur even when other ranges are preserved, it captures a large fraction of true FAI cases, making it the test with the highest sensitivity among common physical findings for this condition. Other signs, like pain with resisted hip abduction or a positive FABER test, can indicate hip pathology but are not as consistently present in FAI and therefore are less sensitive. Limited external rotation with the hip flexed can occur with FAI as well, but its sensitivity is typically lower than that of the FADIR maneuver. In practice, a positive pain response with the FADIR test is the most helpful single finding for recognizing FAI on physical examination, though it’s best interpreted in the context of the patient’s history and imaging.

The key idea is which exam maneuver most reliably picks up femoroacetabular impingement (FAI) across patients — its presence is defined by pain reproduced during the test.

Reproducing pain with the FADIR maneuver (flexion, adduction, internal rotation) is most sensitive for detecting FAI. This position narrows the space between the femoral head-neck junction and the acetabular rim, so if there is impingement, the abnormal contact commonly provokes intra-articular pain early in the range. Because this sign tends to occur even when other ranges are preserved, it captures a large fraction of true FAI cases, making it the test with the highest sensitivity among common physical findings for this condition.

Other signs, like pain with resisted hip abduction or a positive FABER test, can indicate hip pathology but are not as consistently present in FAI and therefore are less sensitive. Limited external rotation with the hip flexed can occur with FAI as well, but its sensitivity is typically lower than that of the FADIR maneuver.

In practice, a positive pain response with the FADIR test is the most helpful single finding for recognizing FAI on physical examination, though it’s best interpreted in the context of the patient’s history and imaging.