Physical exam

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

A practical sequence:

Position	Check
Standing / walking	Gait, foot progression, pelvic obliquity, lumbar posture, single-leg control, Trendelenburg gait, 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, FADIR, FABER, 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 movements for selected athletes

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 may be useful as a screening maneuver but has limited specificity.

Test	A positive finding supports	Limitation
FADIR	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 diagnostic
Log roll	Compatible with impingement-related intra-articular pain.	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. Aggravating maneuvers to test for inguinal hernias should also be performed as this is a competing pathology that can be missed.

References