Exam

A systematic hip examination should reproduce the patient’s familiar pain, identify motion and strength deficits, assess stability, and identify regional pathology. No single maneuver diagnoses labral pathology or FAI syndrome; findings should be interpreted with the history and imaging. 1-3

A practical sequence

Position	Check
Standing / walking	Gait, foot progression, pelvic obliquity, lumbar posture, single-leg control, Trendelenburg sign, squat or step-down when safe.
Seated	Hip flexion and rotation, neurovascular screen, lumbar screen, pain with resisted hip flexion if relevant.
Supine	Compare ROM bilaterally; log roll; FADIR; FABER; straight-leg raise; resisted straight-leg raise; palpation where appropriate.
Lateral decubitus	Abductor strength and pain, trochanteric tenderness, external snapping, gluteal loading.
Prone / functional	Hip extension and rotation, posterior tenderness/hamstring testing, rectus femoris flexibility; sport-specific movement only if it adds information.

Measure flexion, internal rotation, and external rotation in a standardized position and compare sides. A restricted or painful arc may be more useful than a single end-range number. Record whether each test reproduces the familiar pain and where it is felt. FADIR is a sensitive screen in many series but has limited specificity; it supports a compatible syndrome rather than proving a labral tear. 1,2

Test	A positive finding supports	Limitation
FADIR	Anterior hip/groin pain with flexion, adduction, internal rotation; compatible with impingement-related intra-articular pain.	Commonly positive in other hip disorders; interpretation depends on pain location and context.
FABER	Groin pain may be intra-articular; posterior pain may implicate SI/posterior structures; lateral pain can reflect periarticular irritation.	Distance from knee to table alone is not a diagnosis.
Log roll	Intra-articular irritability or capsular laxity when excessive/external rotation is asymmetric.	Low specificity; compare with the contralateral side.
Resisted hip flexion / Stinchfield	Iliopsoas-related pain or intra-articular irritability.	Load test, not a localization test in isolation.
Apprehension / extension–external rotation	Anterior instability or capsular insufficiency in the right clinical setting.	Avoid overcalling “instability” in a generally hypermobile patient without symptomatic apprehension.

Regional examination

Examine the lumbar spine, sacroiliac region, abdomen or pelvis when indicated, knee, and the full lower-limb neurologic status. Palpate selectively because focal greater-trochanteric, adductor, pubic, ischial, or deep-gluteal tenderness may redirect the work-up. In patients with suspected instability, assess generalized hypermobility and avoid interpreting a large range of motion as pathologic without symptoms or apprehension.

Documentation should include hip range of motion with position, maneuvers that reproduce familiar pain, strength and Trendelenburg findings, features of instability, the neurologic examination, and relevant negative regional findings.

References