Patrick’s Test / Faber’s Test / Figure Four Test for Hip OA & SIJ Pain

Patrick’s Test also known as Faber’s Test or Figure Four Test is an orthopedic test in order to assess limited hip range of motion in the direction of horizontal adduction, which is commonly limited in patients with hip osteoarthritis. Ross et al. (2003) evaluated this test’s intra-rater reliability and found a good ICC of 0.93. This means that the same tester is able to reach the same conclusion when testing a patient several times. Sutlive et al. (2008) also evaluated its inter-rater reliability when used as a provocation test for the hip joint and found only low inter-rater reliability of k = 0.47. This means that the test has only weak clinical value as a provocation test in practice.
At the same time, Patrick’s test can be used as a pain provocation test for the sacroiliac joint. Schneider et al. (2020) evaluated this test’s accuracy regarding the diagnosis of a painful sacroiliac joint and found a sensitivity of 50% and a specificity of 56%. This means, that this test has only weak clinical value in practice.

Execution: The patient is in supine lying position and the examiner is standing on the affected side.
The patient is asked to flex the ipsilateral knee with the medial side of the heel against the other knee.
While the examiner fixates the contralateral anterior superior iliac spine (ASIS), the patient lowers the ipsilateral knee towards the treatment table as far as possible, while the plantar side of the foot remains in contact with the other knee.
At last, the examiner applies overpressure at the ipsilateral knee of 15kg for 5 seconds

This test is positive if the patient’s familiar pain (usually felt in the Fortin area/posterior joint line of the sacroiliac joint and in the groin in case of hip pain) is reproduced.

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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Other assessments for hip osteoarthritis are:

• The Cluster of Sutlive
• Patrick’s Test / FABER Test
• Signs & Symptoms of Hip OA

Other provocation tests for the SI joint are:

• The Cluster of van der Wurff
• The Cluster of Laslett
• Distraction Test
• Sacral Thrust Test
• Sacroiliac Compression Test
• Gaenslen Test
• Yeoman Test
• Active Straight Leg Raise Test

References

Ross MD, Nordeen MH, Barido M. Test-retest reliability of Patrick’s hip range of motion test in healthy college-aged men. Journal of strength and conditioning research. 2003 Feb 1;17(1):156-61.

Sutlive TG, Lopez HP, Schnitker DE, Yawn SE, Halle RJ, Mansfield LT, Boyles RE, Childs JD. Development of a clinical prediction rule for diagnosing hip osteoarthritis in individuals with unilateral hip pain. Journal of Orthopaedic & Sports Physical Therapy. 2008 Sep;38(9):542-50.

Schneider BJ, Ehsanian R, Rosati R, Huynh L, Levin J, Kennedy DJ. Validity of physical exam maneuvers in the diagnosis of sacroiliac joint pathology. Pain Medicine. 2020 Feb 1;21(2):255-60.