Written by manual therapists Thomas T. Ødegaard and Roar Syltebø

The FABER (Flexion, ABduction, External Rotation) test, or Patrick’s test, is one of the few tests that is used routinely and that has been validated and tested for reliability across several joints. The test has been included in a number of clinical studies and literature reviews concerning examination of both the hip and the pelvis. The test is thought to have acquired the name “Patrick’s test” after Hugh Talbot Patrick (1860–1939), a neurologist who taught at a number of universities in both Europe and the USA (Pollock, 1939; White, 2009).

Indication

The FABER test is indicated whenever hip or SI-joint involvement is suspected. The test should be used routinely alongside other tests when examining the hip and pelvis.

Procedure

The patient lies supine. The clinician lifts the leg to be tested so that the hip is placed in flexion, abduction and external rotation. The heel of the test leg is positioned resting on top of the patella of the contralateral leg. The examiner stabilises the patient’s contralateral hip against the table with a posterior pressure over the Anterior Superior Iliac Spine (ASIS), while the test-side knee is pressed down towards the table. Range of motion, end-feel and any pain and pain location are recorded (Magee, 2007; Maslowski et al., 2010; Sutlive et al., 2008; Cook and Hegedus, 2012).

Interpretation

The FABER/Patrick’s test is interpreted as positive for hip involvement when there is reduced range of motion and/or pain localised anteriorly in the groin or on the adductor side of the thigh. This is also referred to as “Patrick’s sign” (Buckup, 2008). The test is interpreted as negative for hip-related complaints if the knee can be lowered to the examination table or to a position parallel with the opposite leg (Magee, 2007). Traditionally, the end-feel is assessed once the movement reaches its end position, and a hard end-feel has traditionally been interpreted as indicating an intra-articular disorder. We have found only one study that assesses end-feel as part of the interpretation of the FABER test (Ombregt et al., 2002; Sutlive et al., 2008; Kaltenborn, 2011). In the absence of symptoms consistent with hip involvement, the test is interpreted as positive for pelvic girdle-related complaints if the patient’s current pain is provoked ipsilaterally at the sacroiliac joint, or anteriorly corresponding to the symphysis (Albert et al., 2000; Ozgocmen et al., 2008; Lawry et al., 2010).

Regarding testing of the sacroiliac joint

In 1996, Dreyfuss and co-workers published a study in which 12 selected tests for the SI joint were evaluated. Diagnostic blocks of the SI joint were used as the reference standard for whether the patients’ complaints were in fact pelvic girdle-related (Dreyfuss et al., 1996). To reach a diagnosis of SI-joint involvement, 90–100% pain relief was required 20 minutes after the injection. Eighty-five patients were included in the study: 61 women and 24 men. The age of the included patients ranged from 18–87 years. The mean age was 44.5 years. Patients had had their current pain for anywhere from under 3 to more than 24 months. Of the 85 patients, 45 responded positively to the injection, 7 had between 51 and 89% pain relief, and 33 had less than 50% pain relief. Both physicians and chiropractors examined the patients.

For the FABER test, the research group found an overall inter-examiner agreement of 85%. When analysing only the patients on whom physicians and chiropractors agreed, the FABER test had a sensitivity of 69% and a specificity of 16% (Dreyfuss et al., 1996).

In 1998, Slipman and colleagues published a study evaluating the predictive value of a battery of provocation tests for the SI joint. In this study, the diagnosis of sacroiliac joint syndrome was based on a test cluster consisting of 6 provocation tests for the SI joint. The diagnosis was made if three of the tests were positive. The FABER test and palpatory tenderness over the relevant SI joint were designated as 2 of the 3 required provocation tests. In addition, at least one of the following tests had to be positive: the shear test, standing extension, Gaenslen’s test, and the Yeoman manoeuvre (Slipman et al., 1998). Patients with a positive test cluster were subsequently treated according to a treatment regimen consisting of lumbar stabilisation training, conditioning of the upper and lower extremities, and soft-tissue treatment. Treatment directed specifically at the SI joint, such as manipulation or mobilisation, was avoided. Patients who did not respond to treatment were then given a diagnostic block of the relevant SI joint, after which they rated their pain on a VAS scale and attempted to provoke their pain with movements and activities that would normally be painful. Fifty patients received a diagnostic block — 19 men and 31 women. Of these, 30 patients had more than 80% pain relief following the injection and were included in the group with confirmed sacroiliac joint syndrome. Twenty of the patients — that is, 40% of the patients with a positive test cluster — thus had less than 80% pain relief after the injection. This gives a positive predictive value of 60% for this test cluster. The authors concluded that positive SI-joint provocation tests are not diagnostic of sacroiliac joint syndrome.

The same year, in 1998, Broadhurst and Bond published a study examining the sensitivity and specificity of, among others, the FABER test. Forty patients — 30 women and 10 men — were included in the study. All patients were examined, after which half were injected with local anaesthetic and the other half with saline into the relevant SI joint. Patients were asked to rate the pain provoked during each test on a VAS scale. A positive response to the injection was defined as more than 70% pain relief. None of the patients who received the placebo injection had more than 70% pain relief on the FABER test. Fourteen of the 20 patients who received local anaesthetic had more than 70% pain relief. The authors conclude with a sensitivity of 77% and a specificity of 100% for the FABER test.

In 2000, Albert and co-workers published a large study in which 2,269 pregnant women underwent a standardised examination protocol comprising 15 selected tests. The FABER test was included in the study. Thirty-four pregnant women were also selected for a reliability sub-study. An inter-examiner agreement of 88%, kappa 0.54, was found, corresponding to moderate agreement between examiners.

In this study, five different pain syndromes were distinguished (Albert et al., 2000):

1. Pelvic girdle syndrome: Daily pain in all 3 pelvic joints, confirmed by pain provocation testing of the relevant pelvic joints.

2. Symphysiolysis: Daily pain over the symphysis only, confirmed by provocation of the symphysis. Symphysiolysis does not necessarily imply that movement is present at the symphysis.

3. One-sided sacroiliac syndrome: Daily pain from one SI joint, confirmed by pain provocation from the relevant joint.

4. Double-sided sacroiliac syndrome: Daily pain in both SI joints, confirmed by bilateral pain provocation testing.

5. Mixed picture: The patient does not fit into any of the categories above.

The following diagnostic properties were found for the FABER test:

Sensitivity

Pelvic girdle syndrome: 70% (n=136)

Symphysiolysis: 40% (n=47)

One-sided sacroiliac syndrome: 42% (n=127)

Double-sided sacroiliac syndrome: 40% (n=180)

Specificity: 99% (n=1,734)

In 2002, Kokmeyer and co-workers published a reliability study in which five tests — the distraction test, the compression test, the P4 test, Gaenslen’s test, and the FABER test — were assessed both individually and as a test cluster. Seventy-eight patients (17 women and 61 men) were included and examined by 2 final-year physiotherapy students. For the FABER test, the examiners agreed on 92.31% of patients. This gives a kappa value of 0.62, corresponding to substantial agreement (Kokmeyer et al., 2002).

In 2004, Röst and colleagues published a large study including 870 pregnant women with pelvic girdle pain. The women underwent clinical examination, completed several questionnaires, and information about the pregnancy and the pelvic complaints was obtained by history-taking. In total, between 60 and 75 minutes were spent per patient contact. The FABER test, resisted adduction, and passive hip abduction were among the clinical tests used. The FABER test was the test most frequently positive in this study. 35.8% of the women had a unilaterally positive FABER test, and 35.9% had a bilaterally positive FABER test, giving a combined sensitivity of 71.7%. By comparison, the P4 test was found to have a sensitivity of 66.4% (Röst et al., 2004).

In 2008, Ozgocmen and his research group published a study assessing the ability of pain provocation tests to diagnose acute sacroiliitis at an early stage. The FABER test was among 6 included tests. The properties of the individual tests as well as of various test clusters were assessed. The FABER test had a sensitivity of 54%/66% and a specificity of 62%/51%, the figures relating to the left/right side, respectively (Ozgocmen et al., 2008).

Test clusters for pelvic girdle pain

Kokmeyer and co-workers published a reliability study in 2002 in which the five tests — the distraction test, the compression test, the P4 test, Gaenslen’s test, and the FABER test — were assessed both individually and as a test cluster (termed a “multitest regimen” in the study). Seventy-eight patients (17 women and 61 men) were included and examined by 2 final-year physiotherapy students. All variants of the test cluster had a kappa value for inter-examiner reliability that falls within the range classified as substantial agreement (κ = 0.61–0.80) (Kokmeyer et al., 2002).

	% agreement	Kappa
Test cluster 1/5	83.33	0.63
Test cluster 2/5	92.31	0.74
Test cluster 3/5	93.59	0.70
Test cluster 4/5	96.15	0.71
Test cluster 5/5	98.71	0.66

Van der Wurff and co-workers (2006) examined the diagnostic properties of a test cluster consisting of the same 5 tests assessed by Kokmeyer and colleagues in 2002.

They found the following diagnostic properties:

	Sensitivity	Specificity	LR+	LR−
Test cluster 1/5	100	42.4	1.74	0
Test cluster 2/5	92.6	57.6	2.18	0.13
Test cluster 3/5	85.2	78.8	4.02	0.19
Test cluster 4/5	25.9	81.8	1.43	0.91
Test cluster 5/5	0	100	0	1.00

(van der Wurff et al., 2006)

Ozgocmen’s research group published a study in 2008 assessing the value of several different test clusters for the diagnosis of acute sacroiliitis at an early stage (Ozgocmen et al., 2008). Gaenslen’s test was included both in a cluster of 5 tests (Gaenslen’s test, FABER test, Mennell’s test, P4, and sacral thrust) and in a cluster of 3 tests (Gaenslen’s test, Mennell’s test, and sacral thrust). The right and left sides were assessed separately.

	Sensitivity	Specificity	LR+	LR−	PPV	NPV
Test cluster 3/5	43–45%	83–89%	2.75–4.39	0.60–0.66	44–62%	81–83%
Test cluster 4/5	45%	84–93%	2.75–6.6	0.58–0.66	45–71%	58–66%
Test cluster 2/3	45–55%	83–86%	3.29–3.44	0.52–0.63	50–55%	80–86%

The authors concluded that a combination of SI-joint pain provocation tests is reliable in the early stage of ankylosing spondylitis, but that the discriminative ability of the tests is low. This is clearly reflected in the generally low sensitivity found throughout this study (Ozgocmen et al., 2008).

Literature reviews on pelvic girdle pain

Cattley and co-workers published a literature review in 2002 assessing the validity and reliability of clinical tests for the SI joint. They included 5 articles addressing the FABER test and concluded that the FABER test is neither valid nor reliable as a test for sacroiliac joint involvement (Cattley et al., 2002).

Stuber concluded in 2007 that the literature supports the use of several of the SI-joint tests. However, none of the studies included in their review provided evidence that any individual SI test is superior to the others. Combining several tests increases their sensitivity and specificity and can give more accurate results (Stuber, 2007).

The European guidelines for the diagnosis and treatment of pelvic girdle pain were published in 2008. These guidelines recommend the FABER test as one of 4 pain provocation tests for sacroiliac joint pain (Vleeming et al., 2008).

In 2009, Szadek and colleagues published a literature review including literature up to and including 2007. Seventeen studies were assessed. The FABER test was included in several of these. The authors conclude that the compression test and the P4 test are the best tests for diagnosing SI-joint involvement, and recommend that a minimum of 3 different provocation tests be used to diagnose SI-joint involvement (Szadek et al., 2009).

Cook and Hegedus (2012) give the FABER test, for the examination of pelvic girdle-related complaints, a utility score of 2, meaning that the evidence moderately supports its use (on a scale from 1, strong support, to 3, minimal or no support). This assessment reflects the literature up to 2012. The more recent systematic review described below calls this score into question, as it found that even clusters of pain provocation tests that include the FABER test are not accurate enough to confirm the SI joint as the source of pain (Saueressig et al., 2021).

In 2021, Saueressig and co-workers published a systematic review with meta-analysis assessing the diagnostic accuracy of test clusters — rather than single tests in isolation — for detecting sacroiliac joint pain. Image-guided intra-articular anaesthetic block was used as the reference standard, and the review searched the literature without a lower date limit, ultimately including 5 eligible studies. Across the individual studies, sensitivity for the various clusters ranged from 50% to 95%, and specificity from 11% to 79%; the pooled diagnostic odds ratio was 6.02 (95% CI 1.38–26.32). The FABER/Patrick’s test, together with direct palpatory tenderness over the SI joint, was among the individual tests most consistently represented within the positive clusters evaluated. Using the GRADE framework, the authors rated the certainty of the evidence for both sensitivity and specificity as very low. Their overall conclusion was that clusters of pain provocation tests — including the FABER test as a component — do not provide sufficient diagnostic accuracy to rule in the SI joint as the source of a patient’s pain, although a negative cluster result can be used with somewhat greater confidence to rule the SI joint out. The authors also cautioned that, because the included studies were drawn from highly preselected populations (patients already referred for invasive diagnostic procedures or to specialist SI-joint clinics), the findings may not generalise directly to first-contact primary-care or manual-therapy practice (Saueressig et al., 2021).

Taken as a whole, the literature on the SI joint shows that the FABER/Patrick’s test, whether used alone or as part of a test cluster, varies considerably in sensitivity and specificity between studies, and that it appears more useful for helping to rule out significant SI-joint involvement than for confirming it on its own.

Regarding testing of the hip

In 2008, Sutlive and co-workers published a prospective study of 72 individuals. The purpose of the study was to determine the diagnostic accuracy of clinical hip tests, and the authors also aimed to develop a clinical prediction rule for hip osteoarthritis. The study included 72 participants in Texas, with a mean age of 58.6 years; 56% were women, and approximately 75% of those included had had hip symptoms for more than a year. Twenty-one of these had radiographically verified hip osteoarthritis, which is the gold standard for the diagnosis (Sutlive et al., 2008). All patients were examined by two physiotherapists, who invested extensive training to ensure a correct protocol. The FABER/Patrick’s test was one of five clinical tests used, in addition to pain assessment and ROM measurement with an inclinometer. The results for the FABER test were:

Reliability

	% agreement	Kappa
Inter-examiner agreement in assessment of range of motion		0.90
Inter-examiner agreement in assessment of end-feel	76.7%	0.47

Sensitivity	Specificity	Pos. Likelihood ratio	Neg. Likelihood ratio
57%	71%	1.9	0.61

(Sutlive et al., 2008)

In addition to assessing the FABER test as a stand-alone test, the authors also assessed 5 variables together as a clinical prediction rule. The FABER test was not included in this clinical prediction rule.

The study has been graded as a level 2b study with a QUADAS score of 13/14 in terms of level of evidence and methodological quality. Some of the criticism of this study concerns the limited number of included patients and the small number of positive findings. The study concludes that larger and more numerous studies are needed before these results can be relied upon (Sutlive et al., 2008).

In 2010, Maslowski and co-workers published a study assessing the diagnostic validity of 4 hip provocation tests. The study had a prospective diagnostic design with 50 patients referred due to hip complaints. The diagnosis was verified with a diagnostic block of the relevant hip joint. The mean age of the patients was 60 years; 40% were men, and 68% had complaints in the right hip region. Prior to the injection, patients underwent clinical testing with 4 hip pain provocation tests, of which the FABER test was one. Experienced physicians tested the patients, and all results were recorded for each test. All patients then underwent a diagnostic block, during which correct intra-articular needle placement was confirmed under fluoroscopic guidance. Fifteen minutes after the injection, patients scored their pain on a VAS scale from 0–10, and at the same time recorded their percentage pain relief. VAS scores before and after injection, as well as percentage pain relief, were then analysed. At least 80% pain relief was interpreted as indicating that the pain originated from an intra-articular structure (Maslowski et al., 2010).

The performance of the FABER/Patrick’s test is well described in the article and is based on the description given above (Magee, 2007). The results of the study were as follows:

	At least 80% relief calculated from VAS scoring, n=22/50	At least 80% perceived pain relief, n=26/50
Sensitivity	82	81
Specificity	25	25
Predictive value +	0.46	0.54
Predictive value −	0.64	0.55

The authors conclude that the FABER test is among the most frequently used hip provocation tests and that it is a useful clinical hip test. It is comparatively sensitive but poorly specific. There is therefore a substantial likelihood that the FABER test will also be positive in patients who do not have intra-articular involvement of the relevant hip.

It should be noted that this work has a number of limitations, and its results can be discussed in light of the fact that none of the examiners were blinded, possible low back complaints were neither asked about nor examined, the injection volume may produce additional distension pain, and pain location was not recorded before and after the injection. The entire examined population had pain, and it may therefore be questioned whether it is reasonable to conclude that patients who did not achieve 80% pain relief necessarily did not have hip involvement. No control group of entirely asymptomatic individuals was used.

The article nonetheless concludes that further, larger studies with more participants are needed, but that there is an indication for performing the FABER/Patrick’s test as one of several provocation tests, together with an adequate history. Alone, the test is too non-specific to determine whether intra-articular involvement of the hip is present (Maslowski et al., 2010).

Ross and co-workers (Ross et al., 2003) conducted a study of the FABER/Patrick’s test focusing on test–retest reliability with respect to motion. An inexperienced examiner, who received 15 minutes of instruction in the test procedure, examined 50 healthy 20-year-old college students at a 24-hour interval. The vertical distance between the examined knee, the lateral aspect of the patella, and the examination table was measured and recorded. The results of this study show a test–retest reliability of 0.93. Range of motion of both hips was assessed, and no difference in range of motion was found between the dominant and non-dominant sides. The contralateral side can therefore be used as a control when examining patients in the clinic. The study concludes that it supports use of the FABER/Patrick’s test as reliable for the clinical examination of hip mobility (Ross et al., 2003).

Martin and Sekiya (Martin and Sekiya, 2008) conducted a study examining inter-examiner reliability for 4 clinical hip tests, of which the FABER test was one. Seventy patients were examined by an orthopaedic surgeon and a physiotherapist. They underwent joint training in the test procedure and then examined patients independently. In this study, the test was modified by oscillating the relevant knee down towards the table 5 times. Reproduction of the patient’s symptoms was scored as a positive test. The inter-examiner kappa value in this material was 0.63 for the FABER test. The two examiners agreed in 84% of cases. Criticism of this study includes that not all 70 participants took part in all tests, and that no validity assessment was performed. The authors conclude that there are moderately good results for the FABER test with respect to inter-examiner reliability (Martin and Sekiya, 2008).

A highly active research group, headed by Martin, also published a study in 2008 (Martin et al., 2008) with the aim of studying the clinical accuracy of hip tests in diagnosing hip pathology in potential arthroscopy candidates. This study included 105 patients with hip complaints. The clinical tests were assessed against 50% pain relief following a diagnostic injection of the relevant hip joint. Sensitivity, specificity, and likelihood ratios were calculated.

The FABER test was performed by an orthopaedic surgeon in the same manner as described earlier. The following diagnostic properties were found (figures in parentheses are 95% CI):

Sensitivity	Specificity	Pos. Likelihood ratio	Neg. Likelihood ratio
60 (41–77)	18 (7–39)	0.73 (0.5–1.1)	2.2 (0.8–6)

The study shows high numbers of both false negatives and false positives. The clinical test battery as a whole, and each individual test in particular, was not accurate enough to predict more than 50% pain relief from an injection. There is also a degree of criticism regarding the methodology used here, in terms of injection technique, examination technique, sample selection, and purpose. The authors’ conclusion is that the FABER test is not a clinically accurate test (Martin et al., 2008).

The Australian group led by Mitchell et al. (Mitchell et al., 2003) was one of the first groups to compare clinical findings against MRI, ultrasound, and arthroscopy of the hip. The gold standard for examining intra-articular hip pathology is arthroscopy. The FABER/Patrick’s test was one of 2 clinical tests performed. The technique used is the same as that used in Body Examination. In this material there were 17 patients, of whom 88% (15) had a positive FABER test, while 12% (2) had a negative test. The most interesting finding in this work is that all patients who underwent arthroscopy had pathology within the hip joint, and that 72% of the patients reported that the main location of their pain was in the groin and low back region. The article emphasises the clinical importance of being aware that hip joint pathology can cause low back pain. The article’s conclusion is that the FABER test alone is not sufficient, but that a positive FABER test combined with a positive hip quadrant test should lead to further investigation with MR arthrography (Mitchell et al., 2003).

The Danish research group led by Anders Troelsen (Troelsen et al., 2009) examined clinical tests and ultrasound with a view to diagnosing labral tears of the hip. There were 18 patients with a mean age of 43 years, all of whom had undergone periacetabular osteotomy due to symptomatic dysplasia. All patients underwent 3 clinical tests, ultrasound, and MR arthrography. The FABER/Patrick’s test was performed as described earlier (Magee, 2007), and all examinations were performed prospectively with the examiners blinded to one another. The results of this work for the FABER test were as follows:

Sensitivity	Specificity	Pos. predictive value	Neg. predictive value
7/17 = 41%	1/1 = 100%	7/7 = 100%	1/11 = 9%

The FABER/Patrick’s test proved to be a false negative in 10 patients and a true negative in one patient. The remaining results of the study showed that MRI identified a labral tear in 17 of 18 patients, and that ultrasound had a sensitivity and positive predictive value of 94%. Criticism of the study includes that there are far too few patients included, and that it is a sub-classified group being examined. This makes it difficult to extrapolate the figures from the study to the examination of a healthy hip joint (Troelsen et al., 2009).

Clohisy et al. (Clohisy et al., 2009) focused, in their article, on the clinical presentation of patients with femoroacetabular impingement (FAI). This is a work with level 2 methodological grading. The study comprised 51 patients with symptomatic FAI hips, and the purpose of the study was to describe symptoms, functional and activity status, as well as demonstrate clinical tests. The mean age was 35 years, 57% were men, and the mean duration from symptom onset to diagnosis was 3.1 years. In this material, 52 of 53 hips had a positive FABER/Patrick’s test, corresponding to 98.7% of patients. The study concludes that knowledge regarding patients with FAI is increasing, and that the FABER/Patrick’s test is one of several clinical tests that can be used clinically (Clohisy et al., 2009).

Martin’s research group published a review of a hip examination protocol in 2010. This is a thorough and very well-constructed article. History-taking and various examinations and test routines are discussed. The conclusion remains that considerably more and more rigorous evidence is needed regarding clinical tests of the hip joint. The FABER/Patrick’s test is likely most useful for distinguishing between hip and back complaints (Martin et al., 2010).

Cook and Hegedus (2012) give the FABER/Patrick’s test a utility score of 2 as a hip test, meaning that the evidence moderately supports its use (on a scale from 1, strong support, to 3, minimal or no support). This assessment reflects the literature up to 2012. The more recent systematic reviews described below call this score into question, as they found that the FABER test has weak diagnostic properties and low specificity for intra-articular hip pathology (Reiman et al., 2013; Reiman et al., 2015; Dhillon et al., 2025).

In 2013, Reiman and colleagues published a systematic review with meta-analysis of hip physical-examination tests, drawing on the literature through January 2012. The review found that the great majority of hip provocation tests, including the FABER/Patrick’s test, demonstrate weak diagnostic properties, with the notable exception of the patellar-pubic percussion test for excluding radiographically occult hip fracture, which showed excellent sensitivity (95%) and good specificity (86%). No individual hip provocation test, including the FABER test, was found to have sufficiently strong diagnostic properties to be relied upon in isolation (Reiman et al., 2013). A related meta-analysis by the same research group, published in 2015 and focused specifically on femoroacetabular impingement (FAI) and acetabular labral tears, reached a similar conclusion: too few physical examination tests had been investigated in studies of sufficient quality and volume to guide clinical decision-making with confidence, and further high-quality diagnostic-accuracy research was recommended (Reiman et al., 2015).

In 2017, Tijssen and co-workers published a retrospective study correlating patient history and physical-examination findings, including the FABER test, with arthroscopic findings in patients investigated for suspected FAI or labral pathology. In this material, the FABER test showed a sensitivity of 81% and a specificity of 0% for FAI, again illustrating the test’s tendency towards reasonably high sensitivity but very limited specificity in this patient group (Tijssen et al., 2017).

In 2019, Metcalfe and colleagues published a large systematic review in JAMA, as part of the “Rational Clinical Examination” series, assessing which clinical findings are most strongly associated with radiographically confirmed hip osteoarthritis. The review searched the literature up to November 2019 and used plain radiography as the reference standard, pooling data at the level of the individual hip only where three or more studies reported comparable findings. The authors concluded that no single clinical finding, including the FABER/Patrick’s test, could reliably confirm or exclude hip osteoarthritis on its own. A combination of findings — notably groin pain, pain on internal rotation, and reduced internal rotation range of motion — was more useful for identifying patients likely to have significant radiographic hip OA than any single test in isolation. Simple assessment of hip range of motion, together with observation of pain during that motion, was highlighted as particularly useful for distinguishing patients likely to have OA on imaging from those who are not (Metcalfe et al., 2019).

Most recently, in 2025, Dhillon and co-workers (senior author Kraeutler) published a systematic review conducted according to PRISMA guidelines, searching PubMed, Embase and the Cochrane Library up to February 2025 for studies reporting the diagnostic accuracy of physical examination tests for prearthritic intra-articular hip pathology — labral tears, FAI, and hip microinstability — evaluated against MRI, MR arthrography, ultrasound, intra-articular injection, or direct arthroscopic visualisation. Fifteen studies encompassing a total of 1,378 hips were included. For diagnosing labral tears, four of the included studies reported on the FABER test: sensitivity ranged from 41% to 82%, and specificity from 18% to 100%, depending on the reference standard used. The FABER test achieved the single highest specificity (100%) of any test evaluated for labral tears in this review, though that figure came from one small study with a correspondingly low sensitivity of 41% (Troelsen et al., 2009, as re-analysed within Dhillon et al., 2025). For diagnosing FAI specifically, two studies reported a FABER sensitivity of 81–82% and a specificity of 0–25%. Across all tests evaluated — not only the FABER test — the authors found considerable variability in diagnostic accuracy, and concluded that no single physical examination test can reliably confirm prearthritic intra-articular hip pathology in isolation. They recommended a multifaceted diagnostic approach combining physical examination, patient history and, where indicated, imaging, in line with the Warwick Agreement on femoroacetabular impingement syndrome. Compared with two earlier systematic reviews on the same topic, published in 2012 and 2015, the 2025 review included a higher proportion of studies rated as low risk of bias, but its overall conclusion regarding the FABER test’s limited stand-alone diagnostic value was essentially unchanged from the earlier literature (Dhillon et al., 2025).

Overall, the literature shows that the FABER/Patrick’s test, whatever the target pathology (hip osteoarthritis, labral tear, FAI or SI-joint pain), tends towards moderate-to-high sensitivity but generally poor and highly variable specificity across studies. It is therefore best used as one component of a broader clinical assessment (history, a cluster of tests and imaging where indicated) rather than as a stand-alone diagnostic test.

Body Examination’s suggested interpretation of the FABER/Patrick’s test

The FABER/Patrick’s test is interpreted as positive for hip involvement when there is reduced range of motion and/or pain localised anteriorly in the groin or on the adductor side of the thigh. The test is interpreted as negative for hip-related complaints if the knee can be lowered to the examination table or to a position parallel with the opposite leg without the above-mentioned pain.

In the absence of symptoms consistent with hip involvement, the test is interpreted as positive for pelvic girdle-related complaints if the patient’s current pain is provoked ipsilaterally at the sacroiliac joint, or anteriorly corresponding to the symphysis.

The FABER test is poorly specific, and its sensitivity varies considerably from study to study. It is therefore important that the patient reports any pain provocation precisely, and that the test is used in combination with other pelvic and hip tests.

Body Examination considers the FABER/Patrick’s test to be a very simple clinical test to perform, one that all clinicians should master.

Body Examination’s clinical experience is that the FABER/Patrick’s test can differentiate between complaints in the hip region and complaints in the low back/SI joint.

Body Examination considers it important not to assess the FABER/Patrick’s test solely as a pain/provocation test, but also as a ROM test. It is simple to compare the findings with the contralateral side.

Body Examination recommends overpressure/oscillation of the relevant knee, as this can produce clearer pain provocation both in pelvic girdle-related pain and in hip involvement.

Literature search, updating and translation were carried out with the assistance of AI (Claude, Anthropic). The professional content has been reviewed and quality-assured by the editor-in-chief, Roar Syltebø.

References

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• Clohisy JC, Knaus ER, Hunt DM, Lesher JM, Harris-Hayes M, Prather H. Clinical presentation of patients with symptomatic anterior hip impingement. Clin Orthop Relat Res. 2009 Mar;467(3):638-44. Epub 2009 Jan 7.
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