Monday, September 22, 2008

What FABER test in Hip can tell you is; hip has pathology but CAN NOT specify what the EXACT DISORDER.

Many patients report to us with hip and groin pain (usually unilateral) with pain only on crossed sitting and less often with walking stairs, squatting or getting from squatting. FABER test for inguinal pain is positive & SLR is 80 degree suggests that there is no involvement of SI or lumbar spine. I am surprised that it does not match with any common or remote possible pathologies of hip. If FABER is the only sign what the therapist should do? Let us discuss.

The FABER test: Passively flex, abduct, and externally rotate the hip of the lower extremity that is to be tested while subjects is in a supine position, so that the lateral malleolus of the tested lower extremity rests just superior to their opposite extended knee. The test response for hip disorders is an inguinal pain. Similarly the test response for SI disorder is LBA or posterior sacral pain.

For physio researchers: Measurement can be done like the following way: the vertical distance between a fixed mark on the lateral border of the patella of the tested lower extremity and the treatment table can be measured.

Litareture review: According to an article in archives of physical medicine (2008) Strength and ROM testing of the hip in people with hip osteoarthritis can be performed with good to excellent reliability. For hip pain assessment FABER test, log roll test, and assessment of greater trochanteric tenderness were highly reliable and with confidence level (95%). How ever there is a low reliability for the flexion-internal rotation-adduction impingement test. In a study by Mitchell B et al of the 17 patients whose flexion, abduction, external rotation (FABER) test results were reported at the time of examination, 15 (88%) were positive, and 2 (12%) negative on arthroscopy for hip pathology.

Possible interpretations for FABER test:

1. A partial articular pattern; the test position stress the anterior-medial capsule.
2. Muscle tightness; tight flexors of hip, adductors etc.
NB: these structures must be differentiated in a manner suggested by J.Cyriax.

My suggestions: Arthrokinematic correction + muscle stretching.

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