Patrick's Test (FABER): Purpose, Interpretation, and Clinical Significance

What is a Positive Patrick's Test?

A positive Patrick's Test, also known as the FABER (Flexion, ABduction, External Rotation) test, indicates pain or restricted range of motion during a specific hip maneuver, suggesting potential issues within the hip joint, sacroiliac (SI) joint, or surrounding soft tissues.

Understanding the Patrick's Test (FABER Test)

The Patrick's Test is a widely utilized orthopedic special test designed to assess the hip and sacroiliac (SI) joint. It is named after American orthopedic surgeon Hugh Patrick, but is perhaps more commonly known by its acronym, FABER, which stands for Flexion, ABduction, and External Rotation – the three movements performed simultaneously during the test. This maneuver places the hip joint in a position that stresses its capsule and surrounding structures, as well as applying rotational force to the ipsilateral SI joint.

Purpose of the Patrick's Test

The primary purpose of the Patrick's Test is to help clinicians and trainers differentiate between potential sources of pain in the hip, groin, and buttock regions. It serves as a valuable screening tool to:

• Identify Hip Joint Pathology: Such as osteoarthritis, femoroacetabular impingement (FAI), labral tears, or other intra-articular hip conditions.
• Assess Sacroiliac (SI) Joint Dysfunction: The test can provoke pain originating from the SI joint, indicating instability or inflammation.
• Detect Hip Flexor or Adductor Tightness: Restricted range of motion without significant pain can point to muscle tightness.
• Differentiate Pain Sources: Help distinguish between pain originating from the lumbar spine, hip joint, or SI joint.

How the Patrick's Test is Performed (Brief Overview)

To understand what constitutes a "positive" result, it's helpful to briefly outline the test's execution:

1. Patient Positioning: The individual lies supine (on their back) on an examination table.
2. Figure-4 Position: The examiner passively flexes, abducts, and externally rotates the hip of the tested leg by placing the ankle of that leg on the opposite knee, creating a "figure-4" shape.
3. Stabilization: The examiner stabilizes the opposite anterior superior iliac spine (ASIS) to prevent pelvic rotation.
4. Application of Pressure: The examiner then gently applies overpressure to the medial aspect of the tested knee, allowing it to drop towards the examination table.
5. Observation: The test is completed when resistance is met, or the individual reports pain. The degree to which the knee drops towards the table is also noted.

Interpreting a Positive Patrick's Test

A Patrick's Test is considered positive if the individual experiences pain, apprehension, or significant restriction in the tested hip's range of motion (meaning the knee does not drop below the level of the opposite leg's thigh). The location and nature of the pain are crucial for interpretation:

• Anterior Hip or Groin Pain:

  • Indication: This is the most common finding with hip joint pathology. It suggests issues within the hip joint itself, such as:
    • Femoroacetabular Impingement (FAI): Where abnormal bone growths cause the bones of the hip to rub against each other.
    • Labral Tears: Damage to the cartilage rim around the hip socket.
    • Osteoarthritis: Degeneration of the joint cartilage.
    • Capsulitis: Inflammation of the hip joint capsule.
  • Mechanism: The FABER position compresses the anterior hip capsule and stresses intra-articular structures, provoking pain if they are compromised.

• Posterior Hip or Sacroiliac (SI) Joint Pain:

  • Indication: Pain localized to the buttock region, particularly around the dimples of Venus (over the SI joint), suggests sacroiliac joint dysfunction. This could include:
    • SI Joint Instability or Hypomobility: Leading to inflammation or mechanical irritation.
    • Sacroiliitis: Inflammation of the SI joint.
  • Mechanism: The FABER maneuver applies a rotational stress to the SI joint, which can elicit pain if the joint is dysfunctional.

• Restricted Range of Motion (without significant pain):

  • Indication: If the knee remains significantly elevated and does not drop towards the table, but the individual reports minimal or no pain, it often points to:
    • Tightness of Hip Flexors: Particularly the iliopsoas muscle.
    • Tightness of Hip Adductors: Muscles on the inner thigh.
    • Stiffness of the Hip Joint Capsule: General capsular restriction.
  • Mechanism: These soft tissue restrictions prevent the full range of motion in flexion, abduction, and external rotation.

Clinical Significance and Limitations

While the Patrick's Test is a valuable screening tool, it's essential to understand its role within a comprehensive assessment:

• Not Definitive: A positive Patrick's Test is rarely diagnostic on its own. Its results must be correlated with the individual's history, other orthopedic special tests, and potentially imaging studies (like X-rays or MRI) for an accurate diagnosis.
• Sensitivity vs. Specificity: The test is generally considered sensitive (good at ruling out a condition if negative) but may lack high specificity (meaning a positive result can be due to several different issues).
• Differentiating Pain: It is particularly useful for differentiating between pain originating from the lumbar spine (which typically would not be provoked by this specific hip maneuver), the hip joint, or the SI joint.

When to Seek Professional Advice

If you experience persistent hip, groin, or buttock pain, especially pain that is exacerbated by movements similar to the Patrick's Test, it is crucial to seek professional medical advice. A qualified healthcare professional, such as a physician, physical therapist, or orthopedic specialist, can conduct a thorough examination, perform appropriate diagnostic tests, and develop an individualized treatment plan. Self-diagnosis based solely on the interpretation of a single test is not recommended.