Patrick Test (FABER Test)

Patrick Test is a provocative indirect stress test assists in diagnosis of pathologies at the hip, lumbar and sacroiliac joint. It is also known as the FABER test (Flexion, ABduction, External Rotation) or figure of 4 test.

Patrick’s test was first described by Hugh Talbot Patrick, an American neurologist.

How do you do the FABER Test?

FABER Test interpretation in these steps:

• The patient is supine with one leg extended and the other flexed at the knee.
• The lateral malleolus of the flexed leg lies across the other leg superior to the patella.
• The test may also be performed so that the foot of the flexed leg is in contact with the medial aspect of the knee of the contralateral leg.
• The flexed leg is then allowed to fall into abduction, and from this position the examiner increases the external rotation by increasingly pressing the patient’s knee down toward the examining table with one hand.
• The examiner must immobilize the pelvis on the extended contralateral side to prevent it from moving during the test.

See Also: Gaenslen Test

What is a positive Patrick test mean ?

• Normally the knee of the abducted leg will almost touch the examining table. Comparative measurements of the distance between the knee and the table on both sides are made.
• A difference in mobility with painfully restricted motion in hyperabduction suggests the absence of a hip disorder; observation of normal adductors suggests dysfunction in the ipsilateral sacroiliac joint.
• Hip disorders are excluded by testing range of motion in the hip (especially rotation) and palpating the hip capsule deep in the groin.
• Having the patient demonstrate where the pain is with this test may assist with the interpretation of this test.

Patrick Test or FABER test positive in these situations:

Sarcoiliac joint pain (chief complaint is typically posterior) on external hip rotation:

1. Sacroiliac Joint Dysfunction.
2. Sacroiliitis.

Posterior hip pain on external hip rotation:

1. Posterior hip impingement.

Groin pain on external hip rotation:

1. Intraarticular hip disorder:
   1. Hip Impingement (femoral acetabular impingement FAI).
   2. Hip Labral Tear.
   3. Hip loose bodies.
   4. Hip chondral lesion.
   5. Hip Osteoarthritis.
2. Iliopsoas Strain or Iliopsoas Bursitis.

The FABER test also places the iliopsoas muscle on stretch. Pathology of the iliopsoas, such as an intrapelvic abscess irritating the iliopsoas sheath, leads to pain in this position. This is sometimes called the iliopsoas sign.

See Also: Thomas Test

See Also: Pelvic Anatomy

Accuracy

In the various studies that have assessed the sensitivity and specificity of the FABER Test, there are a wide range of values which is likely reflective of the variety of patients used in each study and the bias that results.

A systematic review ¹ of the literature for Specificity, sensitivity, and predictive values of clinical tests of the sacroiliac joint, the sensitivity & specificity of FABER Test was as following:

• Sensitivity: 69-77 %
• Specificity: 100 %

Another study for accuracy of a clinical examination in determining intra-articular hip pain, found that the FABER test hip has a sensitivity of 60% and specificity of 18%.

Reference

1. Kent Jason Stuber: Specificity, sensitivity, and predictive values of clinical tests of the sacroiliac joint: a systematic review of the literature. J Can Chiropr Assoc. 2007 Mar; 51(1): 30–41. PMID: 17657289.
2. Martin RL, Irrgang JJ, Sekiya JK. The diagnostic accuracy of a clinical examination in determining intra-articular hip pain for potential hip arthroscopy candidates. Arthroscopy. 2008 Sep;24(9):1013-8. doi: 10.1016/j.arthro.2008.04.075. Epub 2008 Jun 16. PMID: 18760208.
3. Bagwell JJ, Bauer L, Gradoz M, Grindstaff TL. THE RELIABILITY OF FABER TEST HIP RANGE OF MOTION MEASUREMENTS. Int J Sports Phys Ther. 2016 Dec;11(7):1101-1105. PMID: 27999724; PMCID: PMC5159634.
4. Campbel’s Operative Orthopaedics 13th Edition Book
5. Clinical Tests for the Musculoskeletal System 3rd Edition Book.
6. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition Book.