Table 3

Description of suggested physical examination tests for diagnosis of an acetabular labral tear

Physical examination testPerformancePositive resultInterpretation
Thomas testThe patient sits at the edge of the plinth. The patient is then instructed to lie back, pulling both knees to his or her chest
One knee (the asymptomatic side) is held to the chest and the other is slowly lowered into the extension of the hip by the clinician. The knee is allowed to extend
The patient is instructed to pull his or her pelvis into posterior rotation. The clinician can use a goniometer to measure the extension angle of the hip and/or the knee
Reproduction of patient's concordant pain with/without a clickThis test demonstrates high SN and SP with a (+) LR/(−) LR of 11.1/0.12, thereby altering the posttest probability of an ALT diagnosis to a moderate to significant degree
FADDIR testThe patient is supine. The clinician passively moves the patient's leg to approximately 90° of hip and knee flexion. The leg is then passively adducted and internally rotatedReproduction of patient's concordant groin painThis test demonstrates high SN and low SP with a (+) LR/(−) LR of 1.02–1.06/0.15–0.48, thereby altering the post-test probability of an ALT diagnosis to a very small to moderate degree
Flexion-internal rotation testThe patient is supine. The clinician passively performs the combined movements of flexion to 90° and internal rotationReproduction of concordant pain/discomfort in the groinThis test demonstrates high SN and low SP with a (+) LR/(−) LR of 1.12/0.27, thereby altering the posttest probability of an ALT diagnosis to a very small to small degree
Scour testThe patient starts in a supine position. The clinician flexes the patient's hip and knee, performing a sweeping motion from external to internal rotation as an axial load is appliedReproduction of the patient's concordant pain or apprehension at a given point during the examinationThese tests all generally demonstrate high SN and low SP with (+) LR/(−) LR thereby altering the posttest probability of an ALT diagnosis to a very small degree or worse
Internal rotation with overpressure testThe patient is supine. The clinician passively performs flexion of the hip to 90°, followed by internal rotation with overpressure at end rangeReproduction of concordant pain/discomfort in the groin
Resisted straight leg raise testThe patient is supine with bilateral legs extended and trunk supported upright with bilateral arms, and raises their leg 30 cm off the table. The clinician applies a downward force at the distal thigh as the patient attempts to resist this forceReproduction of pain in the lower quadrant or anterior hip
Internal rotation-flexion-axial compression testThe patient is supine. The clinician passively performs the combined motions of hip internal rotation, flexion and axial compression (longitudinally through the femur)Reproduction of concordant pain/discomfort in the groin
Postero-inferior labrum testThe patient is supine, close to the edge of the table. The clinician passively moves the hip into hyperextension, abduction and external rotationReproduction of discomfort and apprehension on the part of the patient
  • ALT, acetabular labral tears; FADDIR, flexion-adduction-internal rotation test; (+) LR, positive likelihood ratio; (−) LR, negative likelihood ratio; SN, sensitivity; SP, specificity.