Which combination of tests is most effective in differentiating hip joint pathology from lumbar radiculopathy in a patient with leg pain?

• A. FADIR test alone
• B. SLR test alone
• C. FADIR and Straight-Leg Raise (SLR) together
• D. Trendelenburg test

Answer: (C)

Combining a hip-focused provocative test with a lumbar nerve-tension test gives the clearest clue about where the leg pain is coming from because they target different structures and produce different pain patterns.

FADIR stresses the hip joint by bringing the femur into flexion, adduction, and internal rotation. If this maneuver reproduces groin or hip-specific pain, it suggests intra-articular hip pathology such as femoroacetabular impingement or a labral tear. While not perfectly specific, its pattern helps localize pain to the hip rather than the spine.

The straight-leg raise assesses neural tension along the lumbar nerve roots. Reproduction of radiating leg pain in the dermatomal distribution with this test points toward lumbar radiculopathy rather than primary hip joint pain. It’s less specific for hip pathology but is useful for signaling nerve-root involvement.

Using both tests together maximizes differential accuracy: a positive FADIR with a negative straight-leg raise favors a hip source, a positive straight-leg raise with a negative FADIR favors lumbar radiculopathy, and if both are positive there may be coexisting pathology or a more complex pain generator requiring further evaluation. The Trendelenburg test, while informative for gait and hip abductor strength, does not meaningfully differentiate hip pathology from lumbar radiculopathy in this context, so it’s less helpful for this specific differential.