Diagnosis of femoroacetabular impingement syndrome

Presentation of femoroacetabular impingement syndrome is usually a gradual onset of deep hip pain, usually felt in the groin, made worse with activity, particularly at the extremes of hip range of motion. Several clinical tests have been used in diagnosis, but a 2015 meta-analysis1 showed that the outcomes of these tests did not alter the probability of diagnosing femoroacetabular impingement syndrome. The authors have suggested that the following are useful screening tests for femoroacetabular impingement or acetabular-labral tearReiman, 2015:

  • FADDIR test (flexion, adduction and internal rotation), also known as the impingement test; see this instructional video
  • Flex-IR test (flexion, internal rotation); see this instructional video.
Note: Caution is required when interpreting imaging reports because there is a high prevalence of radiological hip abnormalities in asymptomatic people.

Some suggest that anatomical abnormalities seen on imaging may be associated with, or cause, femoroacetabular impingement syndrome. Hip morphology is often assessed by plain X-ray, computed tomography (CT) or magnetic resonance imaging (MRI) scans; however, caution is required when interpreting the findings because radiological abnormalities can be asymptomatic. A review2 of 26 studies of CT and MRI scans of the hip joint showed a relatively high prevalence of asymptomatic anatomical abnormalities and labral injuriesFrank, 2015.

1 Reiman MP, Goode AP, Cook CE, Hölmich P, Thorborg K. Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: a systematic review with meta-analysis. Br J Sports Med. 2015 Jun;49(12):811. [URL]Return
2 Frank JM, Harris JD, Erickson BJ et al. Prevalence of Femoroacetabular Impingement Imaging Findings in Asymptomatic Volunteers: A Systematic Review. Arthroscopy. 2015 Jun;31(6):1199-204. [URL]Return