The Fabere sign is pain elicited during a specific maneuver of the hip, indicating underlying hip joint pathology such as arthritis, labral injury, or sacroiliac joint disease. The name is derived from the movements involved in the test: Flexion, ABduction, ER (external rotation), and Extension.

Pathophysiology

• Hip joint or sacroiliac joint pathology causes pain when the joint capsule, ligaments, or articular surfaces are stressed during the maneuver.

• Arthritis or labral tears increase friction and compressive forces in the hip joint during combined flexion, abduction, and external rotation.

• Inflammatory or degenerative changes sensitize periarticular tissues, producing pain on passive or resisted movement.

Examination Technique

1. Patient Positioning: Have the patient lie supine on the examination table.

2. Maneuver:

   • Flex the hip and knee of the leg being examined.

   • Externally rotate the hip so the lateral malleolus rests on the opposite knee (forming a “figure-4” position).

   • Stabilize the opposite pelvis and gently depress the knee of the tested leg toward the table.

3. Assessment:

   • Positive Fabere sign: Pain elicited in the hip or sacroiliac region during the maneuver.

   • Note whether pain is felt anteriorly (hip joint) or posteriorly (sacroiliac joint).

Clinical Utility

• Screening: Detects hip joint or sacroiliac joint pathology.

• Localization: Helps distinguish between intra-articular hip pain (anterior groin) versus sacroiliac pain (posterior pelvis).

• Guiding further evaluation: Positive Fabere test may indicate need for imaging (X-ray, MRI, CT) or referral to orthopedics.

Differential Diagnosis

Pediatric considerations

• Rarely used in young children due to cooperation issues.

• May help detect developmental dysplasia of the hip or inflammatory hip disease in older children.

Geriatric considerations

• Commonly positive in osteoarthritis.

• Pain may be more pronounced due to reduced joint space and osteophyte formation.

Limitations

• Pain may be elicited from structures other than the hip, including sacroiliac joint or surrounding muscles.

• Not specific for a single pathology; should be interpreted with history, imaging, and other clinical tests.

Patient counseling

• Explain the purpose of the test and that mild discomfort may occur.

• Reassure that the maneuver is diagnostic and not harmful.

• Advise follow-up for further evaluation if the test is positive.

Conclusion

The Fabere sign is a useful clinical test for assessing hip joint and sacroiliac joint pathology, particularly arthritis and labral injuries. Proper technique and interpretation are essential for localizing pain and guiding further management.

References

1. Magee DJ. Orthopedic Physical Assessment. 7th ed. Philadelphia, PA: Elsevier; 2021.

2. Hoppenfeld S, deBoer P. Physical Examination of the Spine and Extremities. 2nd ed. New York: Appleton & Lange; 2000.

3. Levangie PK, Norkin CC. Joint Structure and Function: A Comprehensive Analysis. 5th ed. Philadelphia, PA: F.A. Davis; 2011.

4. O’Connor FG, et al. Clinical Orthopaedic Examination. 2nd ed. New York: McGraw-Hill; 2010.